Resorbable oxidized cellulose embolization solution

ABSTRACT

A method for forming an embolism within a blood vessel is disclosed. The method includes including: implanting an oxidized cellulose embolization solution into a lumen of a blood vessel to form an embolism within the lumen. The oxidized cellulose is present in an amount from about 10 % by weight to 20 % by weight of the oxidized cellulose embolization solution. The method also includes adjusting recanalization time of the embolism, which may be adjusted by tailoring a degradation rate of the oxidized cellulose.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a continuation in part of U.S. applicationSer. No. 14/210,873 filed Mar. 14, 2014, which claims the benefit of andpriority to U.S. Provisional Patent Application No. 61/791,475, filedMar. 15, 2013, U.S. Provisional Patent Application No. 61/857,332, filedJul. 23, 2013, and U.S. Provisional Patent Application No. 61/952,164,filed Mar. 13, 2014, the entire disclosures of each of which areincorporated by reference herein.

BACKGROUND

Technical Field

The present disclosure relates to systems and methods for dissolvingcellulose. In particular, the present disclosure provides processes fordissolving modified cellulose. The dissolved cellulose may have mayuses, including forming microspheres and slurry useful in embolizationprocedures.

Background of Related Art

Cellulose is the most abundant biorenewable material, andcellulose-derived products have been used in multiple industries,including manufacturing of textiles and medical devices. Apart from theuse of unmodified cellulose-containing materials (for example wood,cotton), modern cellulose technology requires extraction and processingof cellulose from primary sources using techniques that have changedvery little since the inception of the modern chemical industry.

The full potential of cellulose and cellulose products has not beenfully exploited, partially due to the historical shift towardspetroleum-based polymers, and also by the limited number of commonsolvents in which cellulose is readily soluble. Traditional cellulosedissolution processes, including the cuprammonium and xanthateprocesses, are often cumbersome or expensive and require the use ofunusual solvents, typically with a high ionic strength, under relativelyharsh conditions.

Various processes for dissolving cellulose have been previouslydisclosed. See, for example, McCormick, et al. “Solution Studies ofCellulose in Lithium Chloride and N,N-Dimethylacetamide,”Macromolecules, 1985, Vol. 18, No. 12, 1985, pp. 2394-2401; Timpa,“Application of Universal Calibration in Gel Permeation Chromatographyfor Molecular Weight Determination of Plant Cell Wall Polymers: CottonFiber,” J. Agric. Food Chem., 1991, 39, 270-275; and Strli{hacek over(c)} et al., “Size Exclusion Chromatograhy of Cellulose inLiCl/N,N-Dimethylacetamide,” J. Biochem. Biophys. Methods, 2003, 56, pp.265-279.

Improved processes for dissolving cellulose, that overcome the need forhigh thermal treatment, excessive physical manipulation (e.g.,stirring), and/or lengthy treatment periods, all of which contribute tothe degradation of the cellulose and removal of oxidized groups fromoxidized cellulose, remain desirable.

SUMMARY

According to one embodiment of the present disclosure, a method forforming an embolism within a blood vessel is disclosed. The methodincludes introducing an oxidized cellulose embolization solutionincluding an oxidized cellulose into a lumen of a blood vessel to forman embolism within the lumen.

According to one aspect of the above embodiment, the method furtherincludes guiding an implantation device including the oxidized celluloseembolization solution through the lumen, which may also include imagingthe blood vessel.

According to one embodiment of the present disclosure a method fortreating a tumor is disclosed. The method includes identifying at leastone arterial blood vessel supplying blood to a tumor; guiding animplantation device including an oxidized cellulose embolizationsolution through a lumen of the at least one arterial blood vessel; andintroducing the oxidized cellulose embolization solution into the lumenthrough the implantation device to form an embolism within the lumen andimpede supply of blood to the tumor.

According to one aspect of the above embodiment, guiding theimplantation device includes imaging the at least one arterial bloodvessel.

According to one aspect of any of the above embodiments, the oxidizedcellulose is present in an amount from about 10% by weight to 20% byweight of the oxidized cellulose embolization solution.

According to one aspect of any of the above embodiments, the oxidizedcellulose embolization solution includes a solvent selected from thegroup consisting of N-methyl-2-pyrrolidinone, dimethyl sulfoxide, andcombinations thereof.

According to one aspect of any of the above embodiments, the oxidizedcellulose embolization solution includes at least one of a bioactiveagent, a visualization agent, a radioactive material, a hemostaticagent, or a radio-protective agent.

According to one aspect of any of the above embodiments, the methodfurther includes adjusting recanalization time of the embolism.Adjustment of the recanalization time includes adjusting a degradationrate of the oxidized cellulose. Adjustment of the degradation rate ofthe oxidized cellulose includes adjusting at least one of degree ofoxidation or molecular weight distribution of the oxidized cellulose.

BRIEF DESCRIPTION OF DRAWINGS

Various embodiments of the present disclosure will be described hereinbelow with reference to the figures wherein:

FIG. 1 is a schematic diagram of a system for dissolving cellulose inaccordance with the present disclosure;

FIG. 2 is a schematic diagram of a doubly-encapsulated microsphere inaccordance with the present disclosure;

FIG. 3 is a schematic diagram of a multi-encapsulated microsphere inaccordance with the present disclosure;

FIG. 4 is a plot of a release profile of a multi-encapsulatedmicrosphere including a plurality of bioactive agents in accordance withthe present disclosure;

FIG. 5 is a plot of a release profile of a multi-encapsulatedmicrosphere including a single bioactive agent in accordance with thepresent disclosure;

FIG. 6 is a schematic diagram of a multi-encapsulated microsphereincluding two types of microspheres in accordance with the presentdisclosure;

FIG. 7 is a schematic process diagram of multi-encapsulated microsphereincluding encapsulated first and second precursors in accordance withthe present disclosure;

FIG. 8 is a schematic process diagram of multi-encapsulated microsphereincluding encapsulated first precursors and double-encapsulated secondprecursors in accordance with the present disclosure;

FIG. 9 is a schematic diagram of a multi-encapsulated microsphereincluding three types of microspheres in accordance with the presentdisclosure;

FIG. 10 is a schematic diagram depicting treatment of a tumor withmulti-encapsulated microspheres including endothermic and exothermicreactants in accordance with the present disclosure;

FIG. 11 is a diagram of treatment of a tumor with embolizationmicrospheres in accordance with the present disclosure;

FIG. 12 is a schematic diagram of a liquid embolic composition having avisualization agent and oxidized cellulose microspheres in accordancewith the present disclosure;

FIG. 13 is a schematic diagram of a liquid embolic composition havingoxidized cellulose microspheres with a visualization agent in accordancewith the present disclosure;

FIG. 14 is a schematic diagram of a liquid embolic composition having avisualization agent and oxidized cellulose microspheres with a bioactiveagent in accordance with the present disclosure;

FIG. 15 is a schematic diagram of a liquid embolic composition havingoxidized cellulose microspheres with a visualization agent and abioactive agent in accordance with the present disclosure;

FIG. 16 is a schematic diagram of a liquid embolic composition having abioactive agent and oxidized cellulose microspheres with a visualizationagent in accordance with the present disclosure;

FIG. 17 is a schematic diagram of a liquid embolic composition having avisualization agent and oxidized cellulose microspheres with a pluralityof bioactive agents in accordance with the present disclosure;

FIG. 18 is a graph of a chromatogram of oxidized cellulose dissolved inaccordance with the present disclosure;

FIG. 19 is a graph of a chromatogram of non-modified cellulose dissolvedin accordance with the present disclosure; and

FIGS. 20A-B are scanning electron microscope images of oxidizedcellulose microspheres in accordance with the present disclosure;

FIGS. 21A-B are scanning electron microscope image of oxidized cellulosemicroparticles including 18% loaded vitamin B-12 in accordance with thepresent disclosure;

FIGS. 22A-B are scanning electron microscope images of oxidizedcellulose microparticles including bupivacaine free base in accordancewith the present disclosure;

FIGS. 23A-B are scanning electron microscope images of oxidizedcellulose microspheres including bupivacaine hydrochloride form inaccordance with the present disclosure;

FIG. 24 is an ultraviolet-visible spectroscopy standard calibrationcurve for vitamin B-12 in accordance with the present disclosure;

FIGS. 25A-B are scanning electron microscope images of oxidizedcellulose microparticles including 30% loaded vitamin B-12 in accordancewith the present disclosure;

FIGS. 26A-B are scanning electron microscope images of oxidizedcellulose microparticles including 25% loaded vitamin B-12 in accordancewith the present disclosure;

FIG. 27 is a light microscope image of cis-diamminedichloroplatinum(II)loaded oxidized cellulose microspheres in accordance with the presentdisclosure;

FIG. 28 is a light microscope image of poly-D,L,-lactide microspheresencapsulating cis-diamminedichloroplatinum(II) loaded oxidized cellulosemicrospheres of FIG. 27 in accordance with the present disclosure;

FIG. 29 is a scanning electron microscope image of a cross-section ofthe microsphere of FIG. 19 in accordance with the present disclosure;

FIG. 30 is a scanning electron microscope image of a cross-section of amicrosphere including a magnetic material in accordance with the presentdisclosure;

FIG. 31 is an angiogram of a blood vessel prior to embolization inaccordance with the present disclosure;

FIG. 32 is an angiogram of the blood vessel of FIG. 31 with oxidizedcellulose microspheres containing iodine in accordance with the presentdisclosure;

FIG. 33 is an angiogram of a blood vessel prior to embolization inaccordance with the present disclosure;

FIG. 34 is an angiogram of the blood vessel of FIG. 33 with oxidizedcellulose embolization slurry containing iodine in accordance with thepresent disclosure;

FIG. 35 is a plot of a conductometric titration curve of oxidizedcellulose in accordance with the present disclosure;

FIG. 36 is a plot of a pH-metric titration curve of oxidized cellulosein accordance with the present disclosure;

FIG. 37 is an angiogram of a blood vessel prior to embolization inaccordance with the present disclosure; and

FIG. 38 is an angiogram of the blood vessel of FIG. 33 with oxidizedcellulose embolization slurry containing iodine in accordance with thepresent disclosure.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The present disclosure provides a system and method for dissolvingcellulose. In embodiments, the present disclosure provides a processusing a polar aprotic solvent and a salt, which is added in a step-wisemanner to dissolve oxidized or non-modified cellulose. The dissolutionprocess according to the present disclosure minimizes degradation of theoxidized cellulose, by conducting the process in an inert and dryatmosphere, introducing the salt in a specific sequence, heating thesolution at a predetermined temperature and time, and minimizingshearing forces on the solution.

As described herein, cellulose includes natural (e.g., non-modified) ormodified (e.g., treated) celluloses including, but not limited to,oxidized cellulose, alkyl celluloses, hydroxyalkyl celluloses, celluloseethers, cellulose esters, nitrocelluloses, combinations thereof, and thelike. Additional examples of suitable modified cellulose derivativesinclude, but are not limited to, methyl cellulose, ethyl cellulose,hydroxypropyl cellulose, hydroxypropyl methyl cellulose, hydroxybutylmethyl cellulose, cellulose acetate, cellulose propionate, celluloseacetate butyrate, cellulose acetate phthalate, carboxymethyl cellulose,cellulose triacetate, and cellulose sulfate sodium salt.

As used herein, oxidized cellulose denotes cellulose having at least aportion of hydroxyl groups replaced by carboxyl, aldehyde, and/or ketonegroups by oxidation. Oxidized cellulose may be formed using anytechnique within the purview of those skilled in the art. For example,cellulose may be oxidized by exposing it to an oxidation medium, such asa densified or supercritical fluid including, but not limited to,nitrogen dioxide, carbon dioxide, combinations thereof, and the like. Inembodiments, the oxidation medium may include a combination of densifiedor supercritical fluids, such as nitrogen dioxide dissolved in carbondioxide. The cellulose material may be exposed to the oxidizing mediumfor a period of time of from about 20 minutes to about 24 hours, inembodiments from about 1 hour to about 5 hours, at a temperature fromabout 20° C. to about 60° C., in embodiments from about 30° C. to about45° C., and at a pressure of from about 20 bars to about 250 bars, inembodiments from about 30 bars to about 90 bars. Methods for oxidizingcellulose materials using densified fluids are disclosed, for example,in U.S. Patent Application Publication No. 2008/0194805, the entiredisclosure which is incorporated by reference herein. Other methods forpreparing oxidized cellulose materials are also disclosed, for example,in U.S. Pat. Nos. 3,364,200; 4,626,253; 5,484,913; and 6,500,777, theentire disclosures, of each of which are incorporated by referenceherein.

Turning now to FIG. 1, a system for dissolving cellulose, includingoxidized cellulose, in accordance with the present disclosure isprovided. System 10 includes a reactor vessel 12, which may be athree-neck round-bottom flask. The reactor vessel 12 includes a gasinlet 14 and a gas outlet 16, both of which are coupled to a source ofinert gas (not shown). The reactor vessel 12 may also include any numberof inlets, spigots, and other connectors to provide for convenientaddition of reactants and/or removal of products to or from the vessel12, respectively. Dissolution of the oxidized cellulose may be carriedout either as a continuous process or a batch process.

The dissolution process is performed in an inert, i.e., oxygen free, anddry atmosphere. In embodiments, the reactor vessel 12 may be purged withan inert gas prior to commencing the dissolution process by circulatingan inert gas through the reactor vessel 12 via the inlet 14 and outlet16. The gas may also be circulated through the reactor vessel 12 duringthe dissolution process. Suitable inert gases include, but are notlimited to, nitrogen and noble gases such as helium, neon, argon, andcombinations thereof.

Initially, a solvent is added to the reactor vessel 12 through anysuitable inlet. In embodiments, the solvent for dissolving oxidizedcellulose may be any polar aprotic organic solvent having a boilingpoint from about 175° C. to about 205° C., in embodiments from about180° C. to about 202° C. Suitable solvents include, but are not limitedto, N,N-Dimethylacetamide, N-methyl-2-pyrrolidinone (NMP), andcombinations thereof.

The solvent may also be sparged (e.g., gas bubbled therethrough) by theinert gas to exclude moisture and dissolved oxygen therefrom. Celluloseis then added to the solvent and may be agitated by a mixer 18 to swellthe cellulose. Mixing is performed at a relatively low rate to preventdegradation of the cellulose. The stirring may be from about 100revolutions per minute (rpm) to about 500 rpm, in embodiments from about150 rpm to about 250 rpm. As described above, the reactor vessel 12 maybe a round-bottomed container, which further minimizes the shearingforces imparted on the cellulose by the mixer 18.

The mixture of the solvent and oxidized cellulose may be heated to atemperature from about 115° C. to about 145° C., in embodiments fromabout 120° C. to about 140° C. in further embodiments from about 130° C.to about 135° C. In embodiments, the degree of oxidation of oxidizedcellulose dissolved using the processes in accordance with the presentdisclosure may be from about 0.2 to about 1.0, in embodiments from about0.3 to about 0.9, in further embodiments from about 0.5 to about 0.7. Asused herein, the term “degree of oxidation” refers to a ratio ofcarboxyl groups to hydroxyl groups of the cellulose, i.e., degree ofoxidation of 0.2 denotes 20% of the hydroxyl groups of the polymeroxidized to carboxylic groups. The “degree of oxidation” is also used asan average degree of oxidation of the entire cellulose sample. Withoutbeing bound by any particular theory, it is believed that thetemperature of the mixture of the solvent and oxidized cellulose dependson the degree of oxidation of the oxidized cellulose. As the degree ofoxidation increases, the temperature required to swell oxidizedcellulose decreases. Conversely, as the degree of oxidation decreases,the temperature required to swell oxidized cellulose increases. Heatingof the cellulose during the dissolution process is minimized. Heating ofthe cellulose may lead to degradation thereof, including destruction ofreactive groups of oxidized cellulose and decrease in molecular weight.

The mixture of the solvent and oxidized cellulose having a degree ofoxidation of about 0.5 or above may be heated to a temperature fromabout 115° C. to about 135° C., in embodiments from about 125° C. toabout 130° C. The mixture of the solvent and oxidized cellulose having adegree of oxidation of from about 0.25 to about 0.5 may be heated to atemperature from about 130° C. to about 145° C., in embodiments fromabout 135° C. to about 140° C.

The solvent initially swells the cellulose due to its relatively highpolarity. Swelling of oxidized cellulose may continue from about 1 hourto about 4 hours, in embodiments from about 1.5 hours to about 2.5hours. After the oxidized cellulose has swelled, the temperature of themixture is reduced. In embodiments, the mixture of oxidized cellulosemay be cooled prior to addition of the salt to a temperature from about90° C. to about 120° C., in embodiments from about 100° C. to about 110°C.

Without being bound by any particular theory, it is believed thatintroduction of the salt into the mixture provides intercalation of thesalt into the cellulose. The swelling of the cellulose with the solventenhances the introduction of the salt into the cellulose, which in turn,affects final dissolution of the cellulose. In embodiments, the salt maybe any alkali halide salt. Suitable salts include, but are not limitedto, lithium halides, such as lithium fluoride, lithium chloride, lithiumbromide, and lithium iodide; sodium halides, such as sodium fluoride,sodium chloride, sodium bromide, and sodium iodide; potassium halides,such as potassium fluoride, potassium chloride, potassium bromide, andpotassium iodide; and any combinations of the foregoing. The salt may bepresent in an amount of from about 0.1% by weight to 3% by weight of theoxidized cellulose, in embodiments from about 0.25% by weight to about2% by weight of the oxidized cellulose. Conventional dissolutionprocesses rely on higher salt concentration to dissolve non-modifiedcellulose, which are unsuitable for dissolving oxidized cellulose. Lowerconcentration of salt prevents or lessens degradation of oxidizedcellulose including destruction of reactive groups of oxidized celluloseand decrease in molecular weight as described above. As used herein,designation of “by weight” may be used interchangeably with “by volume”and denotes “by weight/volume.”

Conducting the dissolution process in a step-wise manner, namely,initial swelling of the cellulose in the solvent prior to introductionof the salt, allows for dissolution of the cellulose at lowertemperatures than conventional processes, which usually requiretemperatures above 150° C. The step-wise dissolution process at lowertemperatures also prevents or lessens degradation of oxidized celluloseincluding destruction of reactive groups of oxidized cellulose anddecrease in molecular weight as described above. In embodiments, thedegree of oxidation of the dissolved oxidized cellulose may be fromabout 80% to about 120% of the degree of oxidation of the pre-processed,i.e., undissolved, oxidized cellulose, in embodiments from about 90% toabout 110%. In embodiments, the molecular weight of the dissolvedoxidized cellulose may be from about 80% to about 100% of the molecularweight of the pre-processed, i.e., undissolved, oxidized cellulose, inembodiments from about 90% to about 95%. As used herein, the term“molecular weight” refers to weight average molecular weight (Mw) of thecellulose. This term “molecular weight” is also used as an averagemolecular mass of the entire cellulose sample. Undissolved (e.g., priorto dissolution) oxidized cellulose may have a molecular weight fromabout 50,000 Daltons to about 500,000 Daltons, in embodiments from about100,000 Daltons to about 400,000 Daltons.

If the oxidized cellulose is not fully dissolved, the process maycontinue with stirring and heating at a lower temperature from about 40°C. to about 80° C., in embodiments from about 50° C. to about 60° C.,for a period of time from about 1 hour to about 5 hours, in embodimentsfrom about 2 hours to about 3 hours, until the oxidized cellulose isdissolved. The resulting solution of oxidized cellulose includesoxidized cellulose present at a concentration of from about 5 milligramsper milliliter (mg/mL) to about 25 mg/mL, in embodiments from about 10mg/mL to about 20 mg/mL.

The system of FIG. 1 may also be used to dissolve non-modifiedcellulose. The process for dissolving non-modified cellulose may utilizethe same solvents as described above for dissolving oxidized cellulose.Initially, the non-modified cellulose is swelled in the solvent. Themixture of the solvent and non-modified cellulose may be heated to atemperature from about 135° C. to about 165° C., in embodiments fromabout 145° C. to about 155° C. The solvent initially swells thecellulose due to its relatively high polarity. Swelling of non-modifiedcellulose may continue from about 1 hour to about 4 hours, inembodiments from about 1.5 hours to about 2.5 hours. After thenon-modified cellulose has swelled, the temperature of the mixture isreduced. In embodiments, the mixture of non-modified cellulose may becooled prior to addition of the salt to a temperature from about 140° C.to about 160° C., in embodiments from about 145° C. to about 155° C.

The salt may be present in an amount of from about 0.1% by weight to 10%by weight of the non-modified cellulose, in embodiments from about 0.5%by weight to about 9% by weight of the non-modified cellulose. If thenon-modified cellulose is not fully dissolved, the process may continuewith stirring and heating at a lower temperature, from about 40° C. toabout 80° C., in embodiments from about 50° C. to about 60° C., for aperiod of time from about 12 hours to about 36 hours, in embodimentsfrom about 16 hours to about 24 hours, until the non-modified celluloseis dissolved.

The dissolved oxidized cellulose may then be used to form macro, microor nanoparticles. In the present application, the terms“macroparticles,” “macrospheres,” “macrocapsules,” “microparticles,”“microspheres,” “microcapsules,” “nanoparticles,” “nanospheres,” and“nanocapsules” denote any particle having any regular or irregular shapeand size from about 0.001 μm to about 2 mm, in embodiments from about0.01 μm to about 1 mm.

Particle formation may be carried out either in as a continuous processwith the dissolution process (e.g., subjecting the solution to highshearing forces, adding neutralizing agents, and/or adding cations) or abatch process. In embodiments, cellulose particles may be formed bysubjecting the dissolved cellulose to high shearing forces (e.g., in ahigh-shear apparatus such as a mixer, extruder, and the like) in thepresence of a solvent or non-solvent, a neutralizing agent, an aqueoussolution having multivalent cations, and combination thereof.

The term “non-solvent”, as used herein, is used in its broadest senseand includes any substance or mixture of substances in which celluloseis not soluble. Suitable solvents and co-solvents include, but are notlimited to, NMP, DMAc and aqueous solutions, and combinations thereof.Suitable non-solvents include, but are not limited to, alkanes, oilsglycerins, glycols, and combinations thereof. The solvent or non-solventmay be present in an amount of from about 1% by weight to 45% by weightof the cellulose, in embodiments from about 5% by weight to about 30% byweight of the cellulose, in embodiments from about 10% by weight to 20%by weight of the cellulose.

In embodiments, oxidized cellulose particles may be formed by contactingthe dissolved cellulose with an aqueous solution having a neutralizingagent. The dissolved cellulose and the aqueous neutralizing solution mayalso be subjected to high shearing forces. In embodiments, theneutralizing agent may be used to neutralize the pendant carboxyl acidgroups in the cellulose to regulate the final particle size andmorphology, so a neutralizing agent herein may also be referred to as a“basic neutralization agent.” Any suitable basic neutralization reagentmay be used in accordance with the present disclosure. In embodiments,suitable basic neutralization agents may include both inorganic basicagents and organic basic agents. Suitable basic agents may includeammonia, ammonium hydroxide, potassium hydroxide, sodium hydroxide,sodium carbonate, sodium bicarbonate, lithium hydroxide, potassiumcarbonate, potassium bicarbonate, combinations thereof, and the like.Suitable basic agents may also include monocyclic compounds andpolycyclic compounds having at least one nitrogen atom, such as, forexample, secondary amines, which include aziridines, azetidines,piperazines, piperidines, pyridines, bipyridines, terpyridines,dihydropyridines, morpholines, N-alkylmorpholines,1,4-diazabicyclo[2.2.2]octanes, 1,8-diazabicycloundecanes,1,8-diazabicycloundecenes, dimethylated pentylamines, trimethylatedpentylamines, pyrimidines, pyrroles, pyrrolidines, pyrrolidinones,indoles, indolines, indanones, benzindazones, imidazoles,benzimidazoles, imidazolones, imidazolines, oxazoles, isoxazoles,oxazolines, oxadiazoles, thiadiazoles, carbazoles, quinolines,isoquinolines, naphthyridines, triazines, triazoles, tetrazoles,pyrazoles, pyrazolines, and combinations thereof. In embodiments, themonocyclic and polycyclic compounds may be unsubstituted or substitutedat any carbon position on the ring.

The neutralizing agent may be utilized as a solid such as, for example,sodium hydroxide flakes and may be dissolved in water to form an aqueoussolution. The neutralizing agent may be added to the oxidized cellulosesuch that the pH of the solution is from about 5 to about 9, inembodiments from about 6 to about 8. As noted above, the basicneutralization agent may be added to neutralize the cellulose possessingcarboxylic acid groups (e.g., oxidized cellulose). Neutralization of thependant carboxylic acids in the formation of cellulose particles byminimizing inter-particle repulsion from anionic charges of thecarboxylic acid groups. The addition of the basic neutralization agentmay thus raise the pH of an emulsion including a cellulose possessingacid groups to a pH of from about 5 to about 12, in embodiments, fromabout 6 to about 11.

In embodiments, oxidized cellulose particles may be formed by contactingthe dissolved cellulose with an aqueous solution having multivalentcations, including divalent and trivalent cations. The dissolvedcellulose and the cation solution may also be subjected to high shearingforces. In embodiments, cellulose particles may be formed by acontinuous two-phase spray preparation, in which a cation solution isinitially sprayed onto a subtracted followed by spraying of a dissolvedcellulose solution. In further embodiments, a cationic solution may becombined with an oxidized cellulose solution to form cross-linked gelsin situ as described in further detail below.

Suitable cations include, but are not limited to, those of calcium(Ca⁺²), barium (Ba⁺²), zinc (Zn⁺²), magnesium (Mg⁺²), iron (Fe⁺², Fe⁺³),platinum (Pt⁺⁴), chromium (Cr⁺⁶), and combinations thereof. Inembodiments, the cation may be introduced by dissolving a suitable saltof the cation, which include, but are not limited to, halides, sulfates,carbonates, phosphates, nitrates, nitrites, oxides, acetates,combinations thereof, and the like. The cations may be present in anamount of from about 0.01% by weight to 25% by weight of the oxidizedcellulose, in embodiments from about 1% by weight to about 18% by weightof the cellulose, in embodiments from about 2% by weight to 15% byweight of the oxidized cellulose depending upon end use of the oxidizedcellulose solution. Cations act as cross-linking agents by cross-linkingpendant carboxylic groups disposed on oxidized cellulose thereby formingcellulose particles. A dual-compartment spraying device (e.g.,micro-fluidizer) may be used which stores the aqueous cation solutionand the oxidized cellulose solution, which ejects the solutioncontemporaneously thereby mixing the particles and forming particlesthat are deposited on a substrate (e.g., tissue). Applicators for mixingtwo components are disclosed in commonly-owned U.S. Pat. Nos. 7,611,494,8,033,483, 8,152,777 and U.S. Patent Application Publication Nos.2010/0065660 and 2010/0096481, the entire disclosures of all of whichare incorporated by reference herein.

In embodiments, the degree of oxidation of the oxidized celluloseparticles formed from the dissolved oxidized cellulose of the presentdisclosure may be from about 80% to about 120% of the degree ofoxidation of the pre-processed, i.e., undissolved, oxidized cellulose,in embodiments from about 90% to about 110%. In embodiments, themolecular weight of the oxidized cellulose particles may be from about80% to about 100% of the molecular weight of the pre-processed, i.e.,undissolved, oxidized cellulose, in embodiments from about 90% to about95%. Undissolved (e.g., prior to dissolution) oxidized cellulose mayhave a molecular weight from about 50,000 Daltons to about 500,000Daltons, in embodiments from about 100,000 Daltons to about 400,000Daltons.

The dissolved cellulose and/or cellulose particles may be used to formvarious medical devices suitable for a variety of surgical and woundapplications. The medical devices according to the present disclosuremay be any structure suitable for being attached or implanted intotissue, body organs or lumens, including, but not limited to, micro andnano-particles, woven and non-woven fabrics, coatings, patches, films,foams, slit sheets, pledgets, tissue grafts, stents, scaffolds,buttresses, wound dressings, meshes, and/or tissue reinforcements.

In embodiments, as noted above, one or more bioactive agents may beadded to the solvent such that the bioactive agents are incorporatedinto the oxidized cellulose solution, which may then be used to formvarious medical devices. A variety of bioactive agents, including polarand non-polar compounds, are soluble in the solvents described-abovesuitable for forming oxidized cellulose solutions according to thepresent disclosure. In embodiments, the bioactive agent may also beadded after the oxidized cellulose particles have been formed. The terms“bioactive agent” and “active therapeutic agent” (ATA) are usedinterchangeably and in its broadest sense include any substance ormixture of substances that have clinical use. Consequently, bioactiveagents may or may not have pharmacological activity per se, e.g., a dye,or fragrance. Alternatively a bioactive agent could be any agent thatprovides a therapeutic or prophylactic effect, a compound that affectsor participates in tissue growth, cell growth, cell differentiation, ananti-adhesive compound, a compound that may be able to invoke abiological action such as an immune response, or could play any otherrole in one or more biological processes. It is envisioned that thebioactive agent may be applied to the present medical device in anysuitable form of matter, e.g., films, powders, liquids, gels and thelike.

Examples of classes of bioactive agents which may be utilized inaccordance with the present disclosure include anti-adhesives,antimicrobials, analgesics, antipyretics, anesthetics, antiepileptics,antihistamines, anti-inflammatories, cardiovascular drugs, diagnosticagents, sympathomimetics, cholinomimetics, antimuscarinics,antispasmodics, hormones, growth factors, muscle relaxants, adrenergicneuron blockers, antineoplastics, immunogenic agents,immunosuppressants, gastrointestinal drugs, diuretics, steroids, lipids,lipopolysaccharides, polysaccharides, platelet activating drugs,clotting factors and enzymes. It is also intended that combinations ofbioactive agents may be used.

Anti-adhesive agents can be used to prevent adhesions from formingbetween the implantable medical device and the surrounding tissuesopposite the target tissue. In addition, anti-adhesive agents may beused to prevent adhesions from forming between the coated implantablemedical device and the packaging material. Some examples of these agentsinclude, but are not limited to hydrophilic polymers such as poly(vinylpyrrolidone), carboxymethyl cellulose, hyaluronic acid, polyethyleneoxide, poly vinyl alcohols, and combinations thereof.

Suitable antimicrobial agents include triclosan, also known as2,4,4′-trichloro-2′-hydroxydiphenyl ether, chlorhexidine and its salts,including chlorhexidine acetate, chlorhexidine gluconate, chlorhexidinehydrochloride, and chlorhexidine sulfate, silver and its salts,including silver acetate, silver benzoate, silver carbonate, silvercitrate, silver iodate, silver iodide, silver lactate, silver laurate,silver nitrate, silver oxide, silver palmitate, silver protein, andsilver sulfadiazine, polymyxin, tetracycline, aminoglycosides, such astobramycin and gentamicin, rifampicin, bacitracin, neomycin,chloramphenicol, miconazole, quinolones such as oxolinic acid,norfloxacin, nalidixic acid, pefloxacin, enoxacin and ciprofloxacin,penicillins such as oxacillin and pipracil, nonoxynol 9, fusidic acid,cephalosporins, and combinations thereof. In addition, antimicrobialproteins and peptides such as bovine lactoferrin and lactoferricin B maybe included as a bioactive agent in the bioactive coating of the presentdisclosure.

Other bioactive agents include: local anesthetics; non-steroidalantifertility agents; parasympathomimetic agents; psychotherapeuticagents; tranquilizers; decongestants; sedative hypnotics; steroids;sulfonamides; sympathomimetic agents; vaccines; vitamins, such asvitamin A, B-12, C, D, combinations thereof, and the like;antimalarials; anti-migraine agents; anti-parkinson agents such asL-dopa; anti-spasmodics; anticholinergic agents (e.g., oxybutynin);antitussives; bronchodilators; cardiovascular agents such as coronaryvasodilators and nitroglycerin; alkaloids; analgesics; narcotics such ascodeine, dihydrocodeinone, meperidine, morphine and the like;non-narcotics such as salicylates, aspirin, acetaminophen,d-propoxyphene and the like; opioid receptor antagonists, such asnaltrexone and naloxone; anticancer agents; anti-convulsants;anti-emetics; antihistamines; anti-inflammatory agents such as hormonalagents, hydrocortisone, prednisolone, prednisone, non-hormonal agents,allopurinol, indomethacin, phenylbutazone and the like; prostaglandinsand cytotoxic drugs; chemotherapeutics, estrogens; antibacterials;antibiotics; anti-fungals; anti-virals; anticoagulants; anticonvulsants;antidepressants; antihistamines; and immunological agents.

Other examples of suitable bioactive agents also include biologics andprotein therapeutics, such as, viruses, bacteria, lipids, amino acids,cells, peptides, polypeptides and proteins, analogs, muteins, and activefragments thereof, such as immunoglobulins, antibodies, cytokines (e.g.,lymphokines, monokines, chemokines), blood clotting factors, hemopoieticfactors, interleukins (IL-2, IL-3, IL-4, IL-6), interferons (β-IFN,α-IFN, and γ-IFN), erythropoietin, nucleases, tumor necrosis factor,colony stimulating factors (e.g., GCSF, GM-CSF, MCSF), insulin,anti-tumor agents and tumor suppressors, blood proteins, fibrin,thrombin, fibrinogen, synthetic thrombin, synthetic fibrin, syntheticfibrinogen, gonadotropins (e.g., FSH, LH, CG, etc.), hormones andhormone analogs (e.g., growth hormone), vaccines (e.g., tumoral,bacterial and viral antigens); somatostatin; antigens; blood coagulationfactors; growth factors (e.g., nerve growth factor, insulin-like growthfactor); bone morphogenic proteins, TGF-B, protein inhibitors, proteinantagonists, and protein agonists; nucleic acids, such as antisensemolecules, DNA, RNA, RNAi; oligonucleotides; polynucleotides; andribozymes.

The present disclosure also provides for compositions and methods offabricating microspheres encapsulating one or more bioactive agentswithin the oxidized cellulose. Suitable bioactive agents are describedin more detail above. Oxidized cellulose microspheres may have atheoretical bioactive agent loading from about 80% to about 120%, inembodiments from about 90% to about 110%, in further embodiments fromabout 95% to about 105%, in additional embodiments from about 98% toabout 102%. Oxidized cellulose microspheres may have an actual bioactiveagent loading from about 0.01% to about 99.99%, in embodiments fromabout 15% to about 85%, in further embodiments from about 25% to about55%, in additional embodiments from about 40% to about 60%.

Soluble oxidized cellulose, by virtue of being dissolved in a polarsolvent as described above, allows for formation of microspheresincluding hydrophilic bioactive agents encapsulated in the oxidizedcellulose. This may be accomplished by using an oil-in-oil emulsionmethod followed by a solvent extraction step in extraction media. Asused herein the term “emulsion” refers to a mixture of two or moreliquids that are immiscible, in which one liquid form a continuous phaseand the other liquid forms a discontinuous phase. As used herein theterms “discontinuous” and “disperse” phase are used interchangeably andrefer to the compound being dispersed through the continuous phase andmay include the bioactive agent, optional encapsulating polymer and/orcorresponding solvent or solvating agent. As used herein the term“continuous” phase refers to a liquid, such as, oils, that are used toextract the solvent or solvating agent from the discontinuous phase.These liquids are usually immiscible with the solvent employed in thediscontinuous phase. As used herein the terms “thinning agent” and“third” phase are used interchangeably and refer to a liquid thatreduces the viscosity of the continuous phase, is miscible with thecontinuous phase and/or removes residual continuous phase from thesurface of the microsphere. In embodiments, the thinning agent may beimmiscible with the discontinuous phase. As used herein the term“oil-in-oil” emulsion denotes an emulsion in which both the continuousphase and the discontinuous phase are organic liquids.

In forming microspheres of soluble oxidized cellulose by an oil-in-oilsolvent extraction method, one or more hydrophilic bioactive agents maybe added to a solution of oxidized cellulose and are mixed sufficientlyto ensure a uniform suspension or homogeneous solution. Oxidizedcellulose may be present in the solution in an amount from about 0.01%by weight to 45% by weight of the solution, in embodiments, from about1% by weight to about 30% by weight of the solution, in embodiments fromabout 5% by weight to 20% by weight of the solution.

The bioactive agent and oxidized cellulose solution forms thediscontinuous phase, which is added drop-wise to a vessel including aliquid forming a continuous phase. The continuous phase liquid may beany suitable non-polar compound that is immiscible with the polarsolvents used in forming the oxidized cellulose solution. Suitablecontinuous phase liquids include, but are not limited to,petroleum-based oils, such as light, medium or heavy mineral oils (e.g.,mixtures of alkanes having from about 40 carbons to about 60 carbons),plant-based oils, such as cottonseed oil, silicone-based oils, andcombinations thereof. In embodiments, the continuous phase may includetwo or more oils such as, for example, a heavy oil and a light oil, thatcompete for extraction of the discontinuous phase. In embodiments, theheavy oil and the light oil may be present at a ratio of from about 1:10to about 10:1, in embodiments from about 1:3 to about 3:1. Thediscontinuous phase liquid may be present in an amount from about 1% byvolume to about 50% by volume of the continuous phase liquid, inembodiments from about 5% to about 20%.

The vessel possessing the continuous phase may be fitted with a baffle.The vessel may include a mixer with an impeller configured to rotate ata rate of from about 25 rpm to about 60,000 rpm, in embodiments, fromabout 100 rpm to about 15,000 rpm, in further embodiments from about 250rpm to about 5,000 rpm. The stirring may continue from about 5 secondsto about 4 hours, in embodiments, from about 15 seconds to about 1 hour.The rate of rotation may be adjusted to obtain desired particle size.Size of the microspheres may be tailored by modulating the duration andthe speed of homogenization (e.g., stirring of the discontinuous andcontinuous phases), temperature and/or pressure, altering the ratio ofcontinuous to discontinuous phases, the shear rate, and the molecularweight and concentrations of oxidized cellulose and bioactive agents.

Upon completing the transfer of the discontinuous phase solution intothe continuous phase, a third phase liquid may be added to the emulsionto remove the solvent from the discontinuous phase liquid. Suitablethird phase liquids include any compound which is miscible with both thecontinuous and discontinuous phase liquids. The extraction of thesolvent occurs due to the solvent being immiscible in the continuousphase liquid but miscible in the third phase liquid. Suitable thirdphase liquids include isopropyl myristate, hexane, n-heptane,triglycerides and combinations thereof. The third phase liquid may bepresent in an amount from about 300% by volume to about 200% by volumeof the continuous phase liquid, in embodiments from about 140% to about150%.

Removal of the solvent from the continuous phase facilitates formationof microspheres including the bioactive agent encapsulated by theoxidized cellulose. The emulsion may be stirred from about 0.1 hour toabout 24 hours, in embodiments from about 2 hours to about 5 hours, toaid in the extraction of the polar solvent from the microspheres. Themicrospheres may then be collected via filtration and washed (e.g., withn-heptane) to remove any trace of continuous and discontinuous phaseliquids on the surface of the microspheres. The microspheres may then becollected and transferred into a glass scintillation vial under anitrogen or argon overlay. In embodiments, microspheres may also beformed using spray dry and jet mill techniques.

The oxidized cellulose microspheres are also suitable for encapsulatinghydrophilic drugs such as bupivacaine HCl as well as viruses, bacteria,amino acids, peptides, proteins, lipids, vaccines, and combinationsthereof since the oil-in-oil emulsion does not react with the waterbarrier of these bioactive agents.

In other embodiments, the oxidized cellulose solution may also be usedto form various types of fibers. In embodiments, fibers may be solid,hollow, porous, and combinations thereof. Fibers may be formed by anysuitable method, including electrospinning, solution casting, extruding,and combinations thereof. The fibers formed from the oxidized cellulosesolutions may be used to form a variety of medical devices. The medicaldevices according to the present disclosure may be any structuresuitable for being attached or implanted into tissue. Suitablestructures formed from the fibers include, for example, films, foams,slit sheets, pledgets, tissue grafts, stents, scaffolds, buttresses,wound dressings, meshes, and/or tissue reinforcements. In embodiments,the fibers may be used to form non-woven meshes or tapes, which may beused as passive hemostats. The non-woven structure of a fibrous meshformed from an oxidized cellulose solution lends itself to use as awound dressing, due to its ability to filter liquids and/or gases.

The oxidized cellulose solution may also be used to form films and/orcoatings. Coatings or films may be formed by depositing the solution byitself or on a substrate solution-casting, dipping, layering,calendaring, spraying, and combinations thereof. The solvent evaporates,thereby forming the film or coating on a substrate. The films may beincorporated onto other medical devices by applying the solution to thesurface of the device, or portion thereof, utilizing any suitable methodwithin the purview of those skilled in the art.

In embodiments, the oxidized cellulose solution may be used to form asprayable delivery vehicle. In further embodiments, the oxidizedcellulose solution may be combined with a second composition that formsa gel or effects precipitation of the oxidized cellulose as described infurther detail below.

The viscosity of the solution for forming fibers, films, and othermedical devices may be adjusted to achieve a desired viscosity. This maybe accomplished by adding one or more plasticizers. Examples of suitableplasticizers include any biocompatible plasticizer, such as lecithin,dibutyl sebacate, citric acid, alcohol esters, polyethylene glycol,polypropylene glycol, and combinations thereof.

Uses for medical devices formed from the dissolved oxidized celluloseinclude closing and healing visceral wall defects and incisions,including incisions due to the removal of tumors, wounds, anastomoses,and fistulae. The medical devices can improve the healing of agastrointestinal anastomosis and may provide an effective approach forthe management and prevention of fistula. The medical devices may alsoprevent complications of polypectomy (e.g., bleeding and perforation).In embodiments, the medical devices may be reinforced with a mesh (e.g.,formed on a substrate mesh) for the treatment of inguinal hernia and/orincisional hernia.

The rate of in vitro and in vivo biodegradation of medical devicesformed from oxidized cellulose may be regulated by controlling theinitial degree of oxidation of the resultant (e.g., dissolved andprocessed) oxidized cellulose. The greater the degree of oxidation ofthe oxidized cellulose, the faster the rate of biodegradation in vitroand in vivo. The present disclosure provides for processes that minimizethe degradation of the oxidized cellulose during the dissolutionprocess, thereby providing for cellulose having a desired degree ofoxidation. Further, biodegradability of cellulose may be controlled byadjusting the molecular weight and degree of oxidation during thedissolution to provide for predictably degrading oxidized cellulosehaving a predictable degradation profile. Dissolving and processingwithout materially affecting the degree of oxidation allows forpredictable biodegradability of the final products (e.g., medicaldevices). Thus, control of the rate of degradation of the oxidizedcellulose matrix may be accomplished by varying the degree of oxidation,thereby controlling the rate of bioactive agent elution. The degree ofoxidation of the oxidized cellulose may also be adjusted during thedissolution process to achieve a desired degree of oxidation.

Dissolved oxidized cellulose may also be utilized to form in situ gels.Oxidized cellulose solution may be prepared using the methods, e.g.,solvents, conditions, etc., outlined above. The oxidized cellulosesolution may have a pH from about from about 7.0 to about 10.0, inembodiments from about 8.0 to about 9.5. The oxidized cellulose solutionmay be combined with a gelation composition that, upon contacting theoxidized cellulose solution, forms a gel. The gel may be used as anadhesive to seal tissue and/or to provide for delivery of bioactiveagents as described in further detail below.

In embodiments, the oxidized cellulose solution may be combined with acationic material, such as a cationic polysaccharide. In embodiments,the cationic polysaccharide may be chitosan, carboxymethyl chitin, guargum, and combinations, optionally in solution. Chitosan is a naturallinear co-polymer of N-acetyl D-glucosamine (acetylated unit) andD-glucosamine (non-acetylated unit). Chitosan may be produced by partialor full deacetylation of chitin. Chitin may be extracted from naturalsources, e.g., squid, exoskeletons of crustaceans such as shrimp, orvegetable sources such as mushrooms. Chitosan may also be syntheticallyproduced or synthesized by modified microorganisms such as bacteria.

The adhesion of chitosan with other polysaccharides, such as cellulose,includes different kinds of interactions, such as electrostaticinteractions, hydrogen bonds, and hydrophobic interactions, resulting inionic cross-linking with the oxidized cellulose. Chitosan, under certaincircumstances, is a cationic polymer containing NH₃ ⁺ groups. Thepositively charged primary amino groups of chitosan attract anionicgroups of other polymers. Thus, chitosan and anionic polymers are ableto form polyelectrolyte complexes. Polyelectrolyte complex formation mayimprove the mechanical properties of the polymers and lead to newstructures, such as precipitates, films, fibers, and gels.

Adhesion of chitosan with other polymers may also be promoted byenhancing the mechanical properties of the formulation by creatingcovalent bonds between both the components of the adhesive formulation.Chitosan has NH₂ groups which can react covalently with carboxyl groups.Thus, chitosan may be mixed with functionalized polymers having carboxylgroups, such as oxidized cellulose.

The chitosan may have a molecular weight from about 1,000 g/mol to about5,000,000 g/mol, in embodiments from about 5,000 g/mol to about 220,000g/mol. In embodiments, chitosan has a high molecular weight (HMW) offrom about 450,000 g/mol to about 550,000 g/mol. In other embodiments,chitosan has a low molecular weight (LMW) of from about 50,000 g/mol toabout 150,000 g/mol.

A solution of chitosan may be prepared, in embodiments, by dissolvingchitosan in distilled water with a stoichiometric amount of acid, suchas HCl or acetic acid, to ensure the complete protonation of all NH₂groups. The final solution may contain from about 0.5% (w/w) to about 5%(w/w) chitosan, in embodiments from about 2% (w/w) to about 4% (w/w)chitosan. The chitosan solution may have a pH from about from about 1.0to about 7.0, in embodiments from about 2.0 to about 6.0. The lower pHof the chitosan solution allows for suspension of pH sensitive bioactiveagents in one of the solutions, either oxidized cellulose or chitosan,without compromising the bioactivity of the pH sensitive bioactiveagents.

In embodiments, bioactive agents, whose bioactivity is reduced ordestroyed by high pH, such as chemotherapeutic encapsulatedpolypeptides, may be suspended in a chitosan solution and incorporatedinto an in-situ forming gel upon contact with an oxidized cellulosesolution. This gel can be fixed onto a targeted site, such as organs,tissue, etc. and anchor the encapsulated peptide, which then can bereleased. The resulting gel may be either neutral pH upon formation, orthe pH can be adjusted, using the pH of the chitosan solution or theoxidized cellulose solution, to provide a friendly pH environment forthe bioactivity of the peptide to be maintained.

Another suitable composition for gelation with the oxidized cellulosesolution includes an aqueous solution of multi-valent cations, whichforms a gel by ionic cross-linking of the oxidized cellulose andcations. Suitable cations include, but are not limited to, those ofcalcium (Ca⁺²), barium (Ba⁺²), zinc (Zn⁺²), magnesium (Mg⁺²), iron(Fe⁺², Fe⁺³), platinum (Pt⁺⁴), chromium (Cr⁺⁶), and combinationsthereof. In embodiments, the cations may be introduced by dissolving asuitable salt of the cations, which include, but are not limited to,halides, sulfates, carbonates, phosphates, nitrates, nitrites, oxides,combinations thereof, and the like in a suitable solvent such as water,methanol, ethanol, and combinations thereof. The cations may be presentin an amount of from about 0.01% by weight to 25% by weight of thesolution, in embodiments from about 1% by weight to about 18% by weightof the solution, in embodiments from about 2% by weight to 15% by weightof the solution, to achieve a desired mix ratio with the oxidizedcellulose solution. The oxidized cellulose solution and the cationicsolution form a reversible, ionically cross-linked gel. In embodiments,the gel can be made reversible by the addition of anionic solutionsincluding aqueous solutions having a pH of greater than 7.0, such assolutions of urea, ammonia, amino acids such as, lysine and glycine,anionic polysaccharides such as, alginate, dextran, carboxymethylcellulose (“CMC”), and combinations thereof.

A solution of oxidized cellulose may also be contacted with aprecipitation and/or gelation composition that forms a gel by dilutionand/or precipitation of the oxidized cellulose. Precipitation may beaccomplished by contacting the oxidized cellulose solution with acomposition including a solvent or a non-solvent. Suitable gelationcompositions include, but are not limited to, water, saline, phosphatebuffered saline, and combinations thereof. In embodiments, an aqueoussolution of carboxymethyl cellulose may also be used. Carboxymethylcellulose may be present in the solution from about 0.5% by weight orvolume to about 5% by weight or volume, in embodiments, from about 1% byweight or volume to about 2% by weight or volume.

In embodiments, an aqueous solution of any cross-linker having one ormore primary amines including, but not limited to, trilysine, albumin,polyethylene glycol amine, and combinations thereof may be used as aprecipitating gelation composition. In further embodiments, an aqueoussolution of any suitable Schiff-base compound may also be used as aprecipitating gelation composition. As used herein, the term“Schiff-base” compound denotes any compound having a functional groupincluding a carbon-nitrogen double bond with the nitrogen atom connectedto an aryl or an alkyl group having a general formula R₁R₂C═NR₃, whereR₃ and at least one of R₁ or R₂ is an aryl or an alkyl group. SuitableSchiff-base compounds include, but are not limited to, amoxicillin,cephalexin, 2,2-dimethyl benzimidazoline, 2-methyl-2-ethylbenzimidazoline, 2-methyl-2-propyl benzimidazoline, 2-methyl-2-butylbenzimidazoline, 2-methyl-2-hexyl benzimidazoline, 2-methyl-2-decylbenzimidazoline, 2,2-dimethyl-5-methylbenzimidazoline,2-methyl-2-butyl-6-methyl benzimidazoline, 2,2-diethyl benzimidazoline,2,2-diethyl benzimidazoline, 2-ethyl-2-hexyl benzimidazoline,2-methyl-2-isoamyl-5-methyl benzimidazoline, 2,2-dioctylbenzimidazoline, 2,2-didecyl benzimidazoline, 2-propyl-2-pentylbenzimidazoline, 2,2-diethyl-6-ethylbenzimidazoline,2,2-dipropyl-5-isopropylbenzimidazoline,2,2-dipropyl-5-methylbenzimidazoline,2,2-dibutyl-6-methylbenzimidazoline,2,2-dibutyl-6-dodecylbenzimidazoline, 2-methyl-2-propenylbenzimidazoline, 2-ethyl-2-propenyl-5-methylbenzimidazoline,2-methyl-2-butenyl benzimidazoline,2-ethyl-2-butenyl-6-methylbenzimidazoline, 2,2-dihexyl benzimidazoline,2,2-dihexyl-5-methylbenzimidazoline, and combinations thereof.Contacting of Schiff-base compound and/or small molecule cross-linkersolutions with the oxidized cellulose solution results in covalentcross-linking of the oxidized cellulose, which, in turn, produces thegel. In embodiments, the aqueous solution may include CMC as well as theSchiff-base compounds.

In embodiments, a solution of one or more acrylic polymers may also beused to precipitate oxidized cellulose to form gels according to thepresent disclosure. Suitable acrylic polymers include, but are notlimited to, those based on methyl methacrylate, hydroxyethyl acrylate,hydroxyethyl methacrylate, glyceryl acrylate, glyceryl methacrylate,acrylic acid, methacrylic acid, acrylamide, methacrylamide, andcombinations thereof. Suitable solvents include acetone, ethyl acetate,dimethyl ether, and combinations thereof.

Upon contact of the oxidized cellulose solution with the precipitatingcomposition, the gel is formed in situ by the dilution of the solventused to form the oxidized cellulose solution and the subsequentprecipitation of the oxidized cellulose. Since the polar solvent of theoxidized cellulose solution is miscible with water and/or organicsolvents described above, oxidized cellulose precipitates out in theform of a gel due to the dilution of the solvent.

In embodiments, the precipitating composition may include a bioactiveagent, which may be suspended in the precipitating composition. Inembodiments, the bioactive agent may be initially suspended in theprecipitating composition as a plurality of microspheres as describedabove. The microspheres may then be re-suspended in either the oxidizedcellulose composition and/or the gelation composition. The resultingoxidized cellulose gel prevents the migration of the microspheres fromthe target site.

As noted above, the gels formed by the solutions of oxidized celluloseand gelation compositions can be used to deliver bioactive agents totissue or the gels may be used to form articles or coatings thereoncontaining bioactive agents. The gels anchor the bioactive agents,microspheres, microparticles, and combinations thereof, to target sites,e.g., organs, tissues, etc. Microspheres and microparticles containingbioactive agents may be formed using the methods described above bysuspending desired bioactive agents in the oxidized cellulose solutionprior to microsphere or microparticle formation. The resulting particlesmay be suspended in the oxidized cellulose solution, which then may becombined with the cationic and/or chitosan solutions. This may beutilized to secure bioactive agents at the desired sites, includingchemotherapeutic agents (e.g., cis-diamminedichloroplatinum(II)) attumor excision sites, to provide for sustained release ofchemotherapeutic agents from the gel and/or the microparticles securedthereby.

The gelation compositions and/or oxidized cellulose solution may be in aliquid form and placed in a syringe or any other suitable deliveryvehicle, such as a sprayer, for immediate or later use. The solutionsmay be placed in delivery vehicles of different volumes so as to reach aspecific ratio of each component.

The solutions may be applied convergently to a desired tissue site toform a gel thereon. As used herein, the term “convergently” denotes atleast partial overlap of the compositions being applied to the substrate(e.g., tissue, medical device, etc.) either during the applicationprocess (e.g., mid-stream) or on a surface of the substrate.

The solutions used to form the gel may also be directly coated on asubstrate, such as a mesh. The substrate may be prepared by soaking itin the desired solutions and drying (e.g., in an oven or in a laminarflow hood). In embodiments, the process may be repeated several times toensure a proper coating displaying the required adhesive properties forthe selected indication of use, e.g., fixation of extraperitoneal orretroperitoneal meshes, skin flap closure, etc.

The ratio of each component may be adjusted to provide a desiredformulation. Each formulation is characterized by its mix ratio (MR). Asused herein, the term “mix ratio” means the amount of the compoundand/or reactive groups responsible for gelation (e.g., free amine groupsof chitosan and/or amount of cations) versus the amount of free carboxylgroups present on the oxidized cellulose. The mix ratio may be at leastabout 1, in embodiments from about 1 to about 40, in further embodimentsfrom about 10 to about 30. In embodiments, each component of the gel maybe diluted with a buffer prior to use for pH adjustment.

The present disclosure also provides for compositions and methods offabricating microspheres having additional microspheres thereinencapsulating one or more APIs or bioactive agents. FIG. 2 shows amicrosphere 20 having one or more microspheres 22 encapsulated therein.As used herein, “multi-encapsulated microspheres” denote theencapsulation of one or more smaller microspheres 22, e.g., particles,spheres, capsules, and combinations thereof in a single largermicrosphere 20. In embodiments, multi-encapsulated microspheres mayencapsulate one or more bioactive agents at same or different loadinglevels.

In a so-called “primary encapsulation,” soluble oxidized cellulose maybe used to encapsulate a bioactive agent, a water-soluble compound, awater-sensitive chemotherapeutic agent and/or active pharmaceuticalingredient, thereby forming oxidized cellulose microspheres, e.g.,microspheres 22, as described above. Primary encapsulation with solubleoxidized cellulose may be carried out using emulsion-based solventevaporation and/or extraction methods including, but not limited to,single-emulsion methods such as oil-in-water (o/w) and water-in-oil(w/o), double-emulsion methods such as water-in-oil-in-water (w/o/w) andsolid-in-oil-in-water (s/o/w), and non-emulsion based methods, such asfluidized-bed, spray-drying, and casting/grinding methods. The primaryoxidized cellulose microspheres may then be further encapsulated in asecond layer of oxidized cellulose encapsulation, or in anotherbiodegradable polymer, other than oxidized cellulose, in a so-called“secondary encapsulation” forming the microsphere 20 encapsulating themicrospheres 22.

As used herein, the term “biodegradable” in reference to a materialshall refer to the property of the material being able to be absorbed bythe body. In the present application, the terms “biodegradable,”“bioresorbable,” “bioerodable,” and “bioabsorbable” are usedinterchangeably and are intended to mean the characteristic according towhich a material decomposes, or loses structural integrity under bodyconditions (e.g., enzymatic degradation or hydrolysis) or are brokendown (physically or chemically) under physiologic conditions in thebody, such that the degradation products are excretable or absorbable bythe body after a given period of time. The time period may vary, fromabout one hour to about several months or more, depending on thechemical nature of the material. In embodiments, the material may not becompletely absorbed, provided the non-absorbed material is acceptablefor medical use.

Oxidized cellulose microspheres may be formed using oil-in-oilemulsification processes described above. The oxidized cellulosemicrospheres may then be further micro-encapsulated by usingemulsion-based solvent evaporation methods, in which the oxidizedcellulose microspheres are suspended in a solution of a biodegradablepolymer or cross-linked and further encapsulated in another oxidizedcellulose microencapsulation process. The solution may include anysuitable biodegradable polymer, a solvent, and an optional emulsifierand/or a surfactant. In embodiments, additional bioactive agents may beadded to the biodegradable polymer solution, which may be the same ordifferent from the bioactive agent included in the oxidized cellulosemicrospheres. In further embodiments, some rounds of encapsulation mayinclude no bioactive agents based on the desired use and/or performancecharacteristics of multi-encapsulated microspheres (e.g., alteredrelease rate).

Suitable biodegradable polymers used to form microspheres according tothe present disclosure include, but are not limited to, aliphaticpolyesters, polyamides, polyamines, polyalkylene oxalates,poly(anhydrides), polyamidoesters, copoly(ether-esters),poly(carbonates) including tyrosine derived carbonates,poly(hydroxyalkanoates) such as poly(hydroxybutyric acid),poly(hydroxyvaleric acid), and poly(hydroxybutyrate), polyimidecarbonates, poly(imino carbonates) such as such as poly(bisphenolA-iminocarbonate and the like), polyorthoesters, polyoxaesters includingthose containing amine groups, polyphosphazenes, poly(propylenefumarates), polyurethanes, polymer drugs such as polydiflunisol,polyaspirin, and protein therapeutics, biologically modified (e.g.,protein, peptide) bioabsorbable polymers, and copolymers, blockcopolymers, homopolymers, blends, and combinations thereof.

More specifically, aliphatic polyesters include, but are not limited to,polylactide, polylactide-co-glycolide, polylactide-polycaprolactone,homopolymers and copolymers of lactide (including lactic acid, D-,L- andmeso lactide), glycolide (including glycolic acid),epsilon-caprolactone, p-dioxanone (1,4-dioxan-2-one), trimethylenecarbonate (1,3-dioxan-2-one), alkyl derivatives of trimethylenecarbonate, Δ-valerolactone, β-butyrolactone, γ-butyrolactone,ε-decalactone, hydroxybutyrate, hydroxyvalerate, 1,4-dioxepan-2-one(including its dimer 1,5,8,12-tetraoxacyclotetradecane-7,14-dione),1,5-dioxepan-2-one, 6,6-dimethyl-1,4-dioxan-2-one, 2,5-diketomorpholine,pivalolactone, α,α diethylpropiolactone, ethylene carbonate, ethyleneoxalate, 3-methyl-1,4-dioxane-2,5-dione,3,3-diethyl-1,4-dioxan-2,5-dione, 6,8-dioxabicycloctane-7-one, andpolymer blends and copolymers thereof.

Suitable solvents for forming the biodegradable polymer solution of thediscontinuous phase for secondary encapsulation include, but are notlimited to, ethyl acetate, methylene chloride, perchloroethane,trichloroethylene, hexafluoroisopropanol (HFIP), chloroform,tetrahydrofuran, dimethyl formamide, as well as those pharmaceuticalsolvents listed in the ICH Q3C (International Conference onHarmonization—residual solvents used in pharmaceutical processing) andcombinations thereof.

The emulsifier may be present in an amount from about 0.01% by weightand/or volume to about 25% by weight and/or volume of the solvent, inembodiments from about 0.1% by weight and/or volume to about 10% byweight and/or volume of the solvent, in further embodiments from about0.5% by weight and/or volume to about 5% by weight and/or volume of thesolvent. For oil-in-oil processes, the use of an emulsifier is optional.Suitable emulsifiers include, but are not limited to, water-solublepolymers, such as polyvinyl alcohol (“PVA”), polyvinyl pyrrolidone(PVP), polyethylene glycol (PEG), polypropylene glycol (PPG),PLURONICS™, TWEENS™, polysaccharides, phospholipids, and combinationsthereof.

The continuous phase for the secondary encapsulation may also include asurfactant to stabilize the microspheres and adjust the bioactive agentloading efficiency. One, two, or more surfactants may be utilized.Examples surfactants that can be utilized include, for example,polyacrylic acid, methalose, methyl cellulose, ethyl cellulose, propylcellulose, hydroxy ethyl cellulose, carboxy methyl cellulose,polyoxyethylene cetyl ether, polyoxyethylene lauryl ether,polyoxyethylene octyl ether, polyoxyethylene octylphenyl ether,polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate,polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether,dialkylphenoxy poly(ethyleneoxy) ethanol, polyoxamers, combinationsthereof, and the like.

Secondary encapsulation of oxidized cellulose microspheres may includecross-linking the microspheres to stabilize subsequent encapsulation andthen forming a suspension of the microspheres in the biodegradablepolymer solution described above. Oxidized cellulose microspheres may becross-linked using any of the cationic species described above. Thesuspension may then be vortexed or intimately stirred to form anemulsion. In embodiments, the oxidized cellulose microspheres may beimmediately suspended in the biodegradable polymer solution withoutcross-linking.

Emulsion-based solvent evaporation may be accomplished by stirring thesuspension or emulsion at a rate from about 25 rpm to about 60,000 rpm,in embodiments, from about 100 rpm to about 15,000 rpm, in furtherembodiments from about 250 rpm to about 5,000 rpm. The emulsion may bestirred for a period of time from about 5 seconds to about 4 hours, inembodiments, from about 15 seconds to about 1 hour. Stirring may also beused to remove the discontinuous phase solvent from the emulsion,retaining the doubly-encased microspheres, or the multi-encasedmicrospheres, i.e., the multi-encapsulated formulation.

For the second round of encapsulation, the solvent may be evaporatedand/or extracted. After the solvent is evaporated and/or extracted, theemulsion retains the microspheres formed from the biodegradable polymerencapsulating the oxidized cellulose microspheres. The emulsion alsoincludes free unencapsulated oxidized cellulose microspheres that aresuspended in the emulsion. The size of the doubly-encased ormulti-encased microspheres may be from about 0.001 μm to about 2 mm, inembodiments the size of the microspheres may be from about 0.01 μm toabout 1 mm, in further embodiments the size of the microspheres may befrom about 0.1 μm to about 500 μm. Size of the microspheres may betailored by modulating the duration and the speed of stirring,temperature and/or pressure, altering the ratio of continuous todiscontinuous phases, the shear rate created during stirring, and themolecular weight and concentrations of biodegradable polymers,emulsifiers, and surfactants, and other variables within purview of aperson skilled in the art.

The primary encapsulation by the oxidized cellulose protects thebioactive agent from organic solvents and/or other conditions used inany subsequent rounds of encapsulation. Oxidized cellulosed may be usedto encapsulate both hydrophilic and hydrophobic bioactive agents. Whilehydrophobic bioactive agents can also be encapsulated using emulsionmethods including other biodegradable polymers, encapsulation ofhydrophilic bioactive agents is particularly facilitated by dissolvedoxidized cellulose.

Soluble oxidized cellulose, by virtue of being dissolved in a polarsolvent as described above, allows for formation of microspheresincluding hydrophilic and/or hydrophobic bioactive agents encapsulatedin the oxidized cellulose whereas other biodegradable polymers arebetter suited to encapsulate hydrophobic bioactive agents. Usingoxidized cellulose for the first round of microencapsulation isbeneficial since it does not dissolve in most polar or non-polarsolvents, with the exception of solvents listed above with respect todissolution of oxidized cellulose, thus eliminating the risk ofmicrosphere dissolution during the second round of encapsulation. Thisallows for microencapsulation of both hydrophobic and hydrophilicbioactive agents, which can then be encapsulated into anothermicrosphere.

In embodiments, the first layer of any microspheres may be formed usinga biodegradable polymer other than oxidized cellulose usingabove-described encapsulation methods, which can then be furtherencapsulated in oxidized cellulose microspheres. Primary encapsulationof bioactive agents using biodegradable polymers may be carried outusing emulsion-based solvent evaporation methods including, but notlimited to, single-emulsion methods such as oil-in-water (o/w) andwater-in-oil (w/o), double-emulsion methods such aswater-in-oil-in-water (w/o/w) and solid-in-oil-in-water (s/o/w), andnon-emulsion based methods, such as fluidized-bed, spray-drying, andcasting/grinding methods.

Where a bioactive agent is first encapsulated in a biodegradablepolymer, the bioactive agent may be dissolved in a solution to form adiscontinuous phase. Suitable solvents for dissolving bioactive agentscould be aqueous and/or organic and include water, saline, methylenechloride, chloroform, and alcohols, examples of which include methanol,ethanol, combinations thereof, and the like. Biodegradable polymer mayalso be dissolved to form a discontinuous phase using the solventsdescribed above. Homogenization may be used for discontinuous phases ifparticle size reduction in the loading of the microsphere is desired.Homogenization may be carried by any suitable methods within the purviewof one skilled in the art including, but not limited to, stirring,grinding, thermal energy, ultrasound energy, combinations thereof, andthe like.

Emulsion-based solvent evaporation may be accomplished by stirring thesuspension or emulsion at a rate from about 25 rpm to about 60,000 rpm,in embodiments, from about 100 rpm to about 15,000 rpm, in furtherembodiments from about 250 rpm to about 5,000 rpm. The emulsion may bestirred for a period of time from about 5 seconds to about 4 hours, inembodiments, from about 15 seconds to about 1 hour. Stirring may also beused to remove the discontinuous phase solvent from the emulsion,retaining the doubly-encased microspheres.

After the solvent is evaporated, the emulsion retains the microspheresformed from the biodegradable polymer encapsulating the bioactive agent.The emulsion also includes free unencapsulated portion of the bioactiveagent that is suspended in the emulsion. The size of the microspheresmay be from about 0.001 μm to about 2 mm, in embodiments the size of themicrospheres may be from about 0.01 μm to about 1 mm, in furtherembodiments the size of the microspheres may be from about 0.1 μm toabout 500 μm. The size of the microspheres may be tailored by modulatingthe duration and the speed of stirring, temperature and/or pressure,altering the ratio of continuous to discontinuous phases, the shear ratecreated during stirring, and the molecular weight and concentrations ofbiodegradable polymers, emulsifiers, and surfactants, and othervariables within purview of a person skilled in the art.

The microspheres formed from the biodegradable polymers other thanoxidized cellulose may then be suspended in a solution of oxidizedcellulose, which is formed according to the processes described above.In forming microspheres of soluble oxidized cellulose by asolid-in-oil-in-oil solvent extraction method, the biodegradable polymermicrospheres may be added to a solution of oxidized cellulose and aremixed sufficiently to ensure a uniform suspension. Oxidized cellulosemay be present in the solution in an amount from about 0.01% by weightto 45% by weight of the solution, in embodiments, from about 1% byweight to about 30% by weight of the solution, in embodiments from about5% by weight to 20% by weight of the solution. In embodiments,additional bioactive agents may be added to the oxidized cellulosesolution which may be the same or different from the bioactive agents ofthe biodegradable polymer microspheres (e.g., hydrophilic vs hydrophobicbioactive agents).

The microspheres, the oxidized cellulose solution, and additionalbioactive agents, if any, form the discontinuous phase, which is addeddrop-wise to a vessel including a liquid forming a continuous phase. Thecontinuous phase liquid may be any suitable non-polar compound that isimmiscible with the polar solvents used in forming the oxidizedcellulose solution. Suitable continuous phase liquids include, but arenot limited to, light, medium or heavy mineral oil (e.g., mixtures ofalkanes having from about 40 carbons to about 60 carbons), cottonseedoil, and combinations thereof. Additional continuous phase may be addedduring emulsification. The discontinuous phase liquid may be present inan amount from about 2% by volume to about 40% by volume of thecontinuous phase liquid, in embodiments from about 5% to about 20%.

Emulsion-based solvent evaporation may be accomplished by stirring thesuspension or emulsion at a rate from about 25 rpm to about 60,000 rpm,in embodiments, from about 100 rpm to about 15,000 rpm, in furtherembodiments from about 250 rpm to about 5,000 rpm. The emulsion may bestirred for a period of time from about 5 seconds to about 4 hours, inembodiments, from about 15 seconds to about 1 hour. Stirring may also beused to remove the discontinuous phase solvent from the emulsion,retaining the doubly-encased microspheres.

Upon completing the transfer of the discontinuous phase solution intothe continuous phase, a third phase liquid may be added to the emulsionto remove or extract the solvent from the discontinuous phase liquid.Suitable third phase liquids include any compound which is miscible withthe continuous and may be miscible with discontinuous phase solvent. Theextraction of the solvent occurs due to the solvent being immiscible inthe continuous phase liquid but miscible in the third phase liquid.Suitable third phase liquids include isopropyl myristate, hexane,triglycerides and combinations thereof. The third phase liquid may bepresent in an amount from about 300% by volume to about 200% by volumeof the continuous phase liquid, in embodiments from about 140% to about150%.

Extraction of the solvent from the discontinuous phase facilitatesformation of doubly-encased microspheres including the bioactive agentencapsulated by a biodegradable polymer, other than oxidized celluloseand then further encapsulated by the oxidized cellulose. The emulsionmay be stirred from about 0.1 hour to about 24 hours, in embodimentsfrom about 2 hours to about 5 hours, to aid in the extraction of thepolar solvent from the microspheres. The microspheres may then becollected via filtration and washed (e.g., with n-heptane) to remove anytrace of continuous and discontinuous phase liquids on the surface ofthe microspheres. The microspheres may then be collected and transferredinto a glass scintillation vial under a nitrogen or argon overlay. Inembodiments, the microspheres may be cross-linked with a cationicsolution and then dried.

In further embodiments, as shown in FIG. 3, doubly-encapsulatedmicrospheres 32, such as those encapsulating microspheres 34, may thenbe further encapsulated in either additional microspheres 30 formed frombiodegradable polymer or the oxidized cellulose, depending on thematerial utilized in the second layer encapsulation. In other words,oxidized cellulose is utilized for every other (e.g., alternate) roundof encapsulation (e.g., microspheres 30 and 34) with adjacent rounds(e.g., microsphere 32) being formed using biodegradable polymers otherthan oxidized cellulose. Thus, in embodiments where dissolved oxidizedcellulose was used in the initial round of encapsulation (e.g., to formthe microsphere 34), biodegradable polymers may be used for the second,(e.g., to form the microsphere 32) fourth, sixth, etc. rounds, and withoxidized cellulose being used in third (e.g., to form the microsphere30), fifth, seventh, etc. rounds. Conversely, in embodiments wherebiodegradable polymers are used in the initial round of encapsulation(e.g., to form the microsphere 34), dissolved oxidized cellulose may beused for the second (e.g., to form the microsphere 32), fourth, sixth,etc. rounds, and with the biodegradable polymers being used in third(e.g., to form the microsphere 30), fifth, seventh, etc. rounds.Subsequent encapsulation using dissolved oxidized cellulose and/orbiodegradable polymers may be carried out in the manner described abovewith respect corresponding encapsulation steps. In further embodiments,every multi-encapsulated layer may be formed from oxidized cellulose.

Multiple encapsulating microspheres offer several therapeutic advantagessuch as, for example, sequential release of multiple bioactive agents asillustrated in plots 41 and 51 of FIGS. 4 and 5. The plot 41 illustratesa release profile of a multi-encapsulated microsphere, e.g., microsphere30, having three unique bioactive agents A, B, and C encapsulated withineach of the microspheres 30, 32, 34, respectively. As the microsphere 30degrades, the bioactive agent A is released, with the release profiledecaying over time corresponding to the degradation of the microsphere30. Thereafter, first encapsulated microsphere 32 begins to degrade,thereby releasing the bioactive agent B. Finally, the third bioactiveagent C is released once the microsphere 34 commences degradation.Release profiles of each of the bioactive agents A, B, and C may betailored by adjusting the amount of the encapsulation material (e.g.,oxidized cellulose and/or biodegradable polymers). In embodiments, therelease profiles may overlap such that one bioactive agent (e.g., A) isreleased concurrently with another bioactive agent (e.g., B). In furtherembodiments, the release profiles of each of the bioactive agents may bediscrete (e.g., not overlapping) based on desired use and therapyrequirements.

The plot 51 illustrates a release profile of a multi-encapsulatedmicrosphere, e.g., microsphere 30, having the same bioactive agent Aencapsulated within each of the microspheres 30, 32, 34. Unlike multiplerelease profiles of distinct bioactive agents A, B, C, encapsulating asingle bioactive agent A provides a burst-like release profile, namely,increased dosages of the bioactive agent A are supplied as each of themicrospheres 30, 32, 34 degrades. In addition, multiple layers providean effective method to further slow-down in the release rate of thebioactive agent.

Multi-encapsulated microspheres provide unique advantages overconventional microspheres that encapsulate one or more bioactive agentsin a single biodegradable microsphere. Encapsulating multiple bioactiveagents in a single-layered microsphere formulation simply provides forsimultaneous release of multiple bioactive agents, rather than for astaggered release profile as illustrated in FIG. 4. With respect to asingle bioactive agent, a single-layered microsphere formulation ischallenging in terms of providing burst and/or pulsatile release ofbioactive agents during its degradation as illustrated in FIG. 5.

Multi-encapsulated microspheres provide for more effective bioactiveagent loading. In embodiments, when a water-soluble hydrophilicbioactive agent is encapsulated in oxidized cellulose as the first layerof encapsulation using an oil-in-oil (o/o) emulsion solvent-evaporationmethod, the water-soluble hydrophilic bioactive agent is not lost in theoil-rich, hydrophobic surroundings and can therefore be effectivelyencapsulated in oxidized cellulose. During the second round ofmicroencapsulation, e.g., with an oil in water o/w method, thewater-soluble hydrophilic bioactive agent already has a protectivelayer, which again results in lower bioactive agent loss to the aqueousmedia, resulting in higher bioactive agent loading, following doubleencapsulation. The advantage of more effective bioactive agent loadingis useful for encapsulating highly hydrophilic bioactive agentmolecules. This is challenging to achieve with more conventional methodsthat employ single-layered encapsulation or those that employ polymersother than oxidized cellulose.

Multi-encapsulated microspheres further provide for additionalprotection of fragile, i.e. more vulnerable to environmental conditions,bioactive agents (e.g. biologics or protein therapeutics).Multi-encapsulation offers a significant advantage in controlling theirrelease while keeping them active and protected from denaturation. Thisis possible for example when a first layer of encapsulation is put inplace with oxidized cellulose, thus providing a protective barrieragainst any harsh conditions in the second (or subsequent) rounds ofmicroencapsulation. This advantage opens up the possibility of effectiveencapsulation and controlled release of some very fragile biologicaltherapeutics (e.g. protein therapeutics).

With respect to FIG. 2, multi-encapsulation also offers the ability forsimultaneous release of multiple bioactive agents. Bioactive agents A,B, and C may be encapsulated individually in the microspheres 22, whichare then encapsulated in the microsphere 20. This allows the bioactiveagents A, B, and C to release simultaneously, while at the same timeensuring that these molecules do not interact with each other prior torelease. Further, an outer encapsulation may be free of any bioactiveagents and may act as a buffer, preventing release of bioactive agentsuntil the outer encapsulation has biodegraded. Thus, multi-layeredencapsulation using oxidized cellulose can facilitate more control overthe timing release of the therapeutic payload.

Microspheres (e.g., single or multi-encapsulated microspheres) accordingto the present disclosure may also incorporate one or more visualizationagents in presence or absence of the bioactive agents. Visualizationagents may be encapsulated into single or multi-encapsulatedmicrospheres using the methods and techniques described above withrespect to bioactive agents. Suitable visualization agents may beselected from among any of the various non-toxic colored dyes suitablefor use in tissue, such as FD&C Blue #1, FD&C Blue #2, FD&C Blue #3, D&CGreen #6, methylene blue, indocyanine green, combinations thereof, andthe like. In embodiments, additional visualization agents may be used,agents which are green or yellow fluorescent under visible light (e.g.,fluorescein or eosin), x-ray contrast agents (e.g., iodinatedcompounds), ultrasonic contrast agents, MRI contrast agents (e.g.,gadolinium containing compounds), CAT or CT scan contract agents (e.g.,barium, barium sulphate, iodine, diatrizoic acid, available asGASTROGRAFIN®, etc.), radionucleotides (e.g., isotopes of technetium,iodine, indium, fluorine), combinations thereof, and the like. Infurther embodiments, the visualization agents may be magnetic materialssuitable for tagging various compounds (e.g., cancer proteins) duringassays. Suitable magnetic materials are described in further detailbelow.

With reference to FIG. 2, the microsphere 20 includes a shellencapsulating one or more smaller microspheres 22 therein. Themicrosphere 20 may include a first visualization agent while themicrosphere 22 may include a second visualization agent, respectively,incorporated thereinto. The first and second visualization agents may bethe same or different. In embodiments, the first and secondvisualization agents are different such that as the microspheres 20 aredegraded after implantation, the first visualization agent is initiallydispersed through the tissue in which the microsphere 20 is introduced,followed by the release of the second visualization agent due to thedegradation of the microspheres 22. Sequential release of the first andsecond visualization agents occurs due to the degradation of themicrosphere 20 prior to the degradation of the microsphere 22.

In addition to the first and second visualization agents, themicrosphere 20 and the microspheres 22 may include first and secondbioactive agents. The combination of the first and second visualizationand first and second bioactive agents allows the healthcare professionalto visualize/monitor progression, such as, track release rate, releasesequence absorption, and other properties of the first and secondbioactive agents. Further, this also allows for the monitoring ofpatient progress and the effectiveness of the bioactive agents.

With reference to FIG. 6, another embodiment a multi-encapsulatingmicrosphere 40 is shown. The microsphere 40 includes a shellencapsulating one or more smaller first microspheres 42 and one or moresmaller second microspheres 44. The first and second microspheres 42include first and second visualization agents and first and secondbioactive agents, respectively. The first and second microspheres 42 and44 may be formed separately prior to encapsulation within themicrosphere 40. In embodiments, the microsphere 40 may include thirdvisualization agent and third bioactive agent. Since the first andsecond microspheres 42 and 44 are encapsulated in the microsphere 40,the microspheres 42 and 44 begin to degrade concurrently. This allowsfor evaluation of the progress of the release of the first and secondbioactive agents, by measuring the ratio of the first visualizationagent to the second visualization agent. In embodiments, themicrospheres 42 may include a first visualization agent and a firstbioactive agent, while the microspheres 44 may include a secondvisualization agent and a second bioactive agent. Thus, the release ofthe first visualization agent corresponds to the release of the firstbioactive agent and the release of the second visualization agentcorresponds to the release of the second bioactive agent. Inembodiments, the microspheres 42 and 44 may be prepared from the same ordifferent materials to tailor absorption rate of the first and secondvisualization and/or bioactive agents.

In other embodiments, with reference to FIG. 3, a doubly-encapsulatingmicrosphere 30 includes a microsphere 32, which further encapsulatesmicrosphere 34 as described in more detail above. In one embodiment, themicrosphere 30 and the microsphere 34 may include first and secondbioactive agents, respectively. The microsphere 32 includes a firstvisualization agent. In this configuration, the first visualization maybe used as a demarcation marker to indicate when the first bioactiveagent of microsphere 30 has been released completely or mostly, prior tothe release of the second bioactive agent from microsphere 34.Sequential release of the first and second bioactive agents occurs dueto the degradation of the microsphere 30 prior to the degradation of themicrosphere 32, followed by the degradation of the microsphere 34.

Microspheres (e.g., single or multi-encapsulated microspheres) accordingto the present disclosure may also incorporate one or more precursors(e.g., hydrogel or adhesive precursors) for forming compositions (e.g.,hydrogels or adhesives) in situ. The hydrogel precursors may be in thepresence or absence of the bioactive agents as described above. Hydrogelprecursors may be encapsulated into single or multi-encapsulatedmicrospheres using the methods and techniques described above withrespect to bioactive agents. With reference to FIG. 7, amulti-encapsulating microsphere 70 is shown, having one or more firstmicrospheres 72 including a first hydrogel precursor and one or moresecond microspheres 74 including a second hydrogel precursor. Afterimplantation, the microsphere 70 prevents immediate polymerization orreaction of the first and second hydrogel precursors. After degradationof the microsphere 70, the microspheres 72 and 74 degrade, therebyreleasing the first and second hydrogel precursors, which then react toform a hydrogel 78. In embodiments, the microsphere 70 may also includeone or more initiators. Encapsulation of the first and second precursorsallows for formation of a gel that is needed after a predeterminedperiod of time, rather than immediately after introduction in vivo. Thetiming of the polymerization and/or activation may be controlled byadjusting the loading of the first and second precursors and/or thethickness of the microspheres, as well as other formulationcharacteristics.

With reference to FIG. 8, a first multi-encapsulating microsphere 80 isshown, having one or more first microspheres 82 including a firsthydrogel precursor and a second multi-encapsulating microsphere 86including a third microsphere 84 having a second hydrogel precursor.After implantation, the microsphere 80 prevents immediate polymerizationof the first and second hydrogel precursors. After degradation of themicrosphere 80, the first microspheres 82 degrade, thereby releasing thefirst hydrogel precursors. The second multi-encapsulating microsphere 86degrades concurrently with the first microspheres 82, delaying therelease of the second hydrogel precursor contained within the secondmicrospheres 84. In embodiments, the microspheres 80 and/or 86 may alsoinclude one or more initiators. This configuration delays the release ofthe second precursor, which also delays cross-linking of the precursorsto form a hydrogel 88, which occurs only after the microspheres 84 havealso degraded.

The above-described hydrogels may be formed from crosslinking the firstand second precursors. The precursor may be a monomer or a macromer. Asused herein the terms “hydrogel precursor(s)”, “first hydrogelprecursor”, and “second hydrogel precursor” may be used to refer tocomponents that may be combined to form a hydrogel, either with orwithout the use of an initiator. Thus, these precursors may, inembodiments, include combinations of reactive precursors and initiatedprecursors. As used herein the terms “reactive precursor(s)”, “firstreactive hydrogel precursor(s)”, and “second reactive hydrogelprecursor(s)” include precursors that may crosslink upon exposure toeach other to form a hydrogel. As used herein the term “initiatedprecursor(s)”, “first initiated hydrogel precursor(s)” and “secondinitiated hydrogel precursor(s)” may be used to describe first andsecond precursors that crosslink upon exposure to an external source,sometimes referred to herein as an “initiator”. Initiators include, forexample, ions, UV light, redox-reaction components, combinationsthereof, as well as other initiators within the purview of those skilledin the art.

The first and second precursors, whether reactive precursors orinitiated precursors, may have biologically inert and water solublecores. When the core is a polymeric region that is water soluble,suitable polymers that may be used include: polyethers, for example,polyalkylene oxides such as polyethylene glycol (“PEG”), polyethyleneoxide (“PEO”), polyethylene oxide-co-polypropylene oxide (“PPO”),co-polyethylene oxide block or random copolymers, and polyvinyl alcohol(“PVA”), poly(vinyl pyrrolidinone) (“PVP”), poly(amino acids),poly(saccharides), such as dextran, chitosan, alginates,carboxymethylcellulose, oxidized cellulose, hydroxyethylcellulose and/orhydroxymethylcellulose, hyaluronic acid, and proteins such as albumin,collagen, casein, and gelatin. In embodiments, combinations of theforegoing polymeric materials may be utilized to form a core. Thepolyethers, and more particularly poly(oxyalkylenes) or poly(ethyleneglycol) or polyethylene glycol (“PEG”), may be utilized in someembodiments.

When the core is small in molecular nature, any of a variety ofhydrophilic functionalities may be used to make the first and secondprecursors water soluble. In embodiments, functional groups likehydroxyl, amine, sulfonate and carboxylate, may contribute to thewater-solubility of a precursor. For example, the N-hydroxysuccinimide(“NHS”) ester of subaric acid is insoluble in water, but by adding asulfonate group to the succinimide ring, the NHS ester of subaric acidmay be made water soluble, without affecting its ability to be used as areactive group due to its reactivity towards amine groups.

In embodiments, a hydrogel may be formed from reactive precursorsthrough covalent, ionic, or hydrophobic bonds. Physical (non-covalent)crosslinks may result from complexation, hydrogen bonding, desolvation,Van der Waals interactions, ionic bonding, combinations thereof, and thelike, and may be initiated by mixing two precursors that are physicallyseparated until combined in situ or as a consequence of a prevalentcondition in the physiological environment, including temperature, pH,ionic strength, combinations thereof, and the like. Chemical (covalent)crosslinking may be accomplished by any of a number of mechanismsincluding, but not limited to, free radical polymerization, condensationpolymerization, anionic or cationic polymerization, step growthpolymerization, electrophile-nucleophile reactions, combinationsthereof, and the like.

In embodiments, the reactive precursor portion of the hydrogel may beformed from a single type of reactive precursor or multiple types ofreactive precursors. In other embodiments, where the hydrogel is formedfrom multiple types of reactive precursors, for example two reactiveprecursors, the reactive precursors may be referred to as a first andsecond reactive precursor. Where more than one reactive precursor isutilized, in embodiments, at least one of the first and secondprecursors may be a crosslinker, and at least one other reactivehydrogel precursor may be a macromolecule, and may be referred to hereinas a “functional polymer”.

In some embodiments, reactive precursors may include biocompatiblemulti-precursor systems that spontaneously crosslink when the precursorsare mixed, but wherein the two or more precursors are individuallystable for the duration of the deposition process. When the reactiveprecursors are mixed in an environment that permits reaction (e.g., asrelating to pH or solvent), the functional groups react with each otherto form covalent bonds. Reactive precursors become crosslinked when atleast some of the reactive precursors can react with more than one otherprecursor. For instance, a precursor with two functional groups of afirst type may be reacted with a crosslinking precursor that has atleast three functional groups of a second type capable of reacting withthe first type of functional groups.

Such reactive components include, for example, first reactive precursorspossessing electrophilic groups and second reactive precursorspossessing nucleophilic groups. Electrophiles react with nucleophiles toform covalent bonds. Covalent crosslinks or bonds refer to chemicalgroups formed by reaction of functional groups on different polymersthat serve to covalently bind the different polymers to each other. Incertain embodiments, a first set of electrophilic functional groups on afirst reactive precursor may react with a second set of nucleophilicfunctional groups on a second reactive precursor. In embodiments, suchsystems include a first reactive precursor including di- ormultifunctional alkylene oxide containing moieties, and a secondreactive precursor including macromers that are di- or multifunctionalamines.

In embodiments the first and second precursors may be multifunctional,meaning that they may include two or more electrophilic or nucleophilicfunctional groups, such that, for example, an electrophilic functionalgroup on the first reactive hydrogel precursor may react with anucleophilic functional group on the second reactive hydrogel precursorto form a covalent bond. At least one of the first or second precursorsincludes more than two functional groups, so that, as a result ofelectrophilic-nucleophilic reactions, the precursors combine to formcrosslinked polymeric products.

In embodiments, each of the first and second precursors include only onecategory of functional groups, either only nucleophilic groups or onlyelectrophilic functional groups, so long as both nucleophilic andelectrophilic reactive precursors are used in the crosslinking reaction.Thus, for example, if the first reactive hydrogel precursor haselectrophilic functional groups such as N-hydroxysuccinimides, thesecond reactive hydrogel precursor may have nucleophilic functionalgroups such as amines. On the other hand, if the first reactive hydrogelprecursor has electrophilic functional groups such as sulfosuccinimides,then the second reactive hydrogel precursor may have nucleophilicfunctional groups such as amines or thiols.

In embodiments, a multifunctional electrophilic polymer such as amulti-arm PEG functionalized with multiple NHS groups may be used as afirst reactive hydrogel precursor and a multifunctional nucleophilicpolymer such as trilysine may be used as a second reactive hydrogelprecursor. The multi-arm PEG functionalized with multiple NHS groupsmay, for example, have four, six or eight arms and a molecular weight offrom about 5,000 to about 25,000. Other examples of suitable first andsecond precursors are described in U.S. Pat. Nos. 6,152,943, 6,165,201,6,179,862, 6,514,534, 6,566,406, 6,605,294, 6,673,093, 6,703,047,6,818,018, 7,009,034, and 7,347,850, the entire disclosures of each ofwhich are incorporated by reference herein.

Synthetic materials that are readily sterilized and avoid the dangers ofdisease transmission that may accompany the use of natural materials maythus be used. Indeed, certain polymerizable hydrogels made usingsynthetic precursors are within the purview of those skilled in the art,e.g., as used in commercially available products such as FOCALSEAL®(Genzyme, Inc.), COSEAL® (Angiotech Pharmaceuticals), and DURASEAL®(Confluent Surgical, Inc). Other known hydrogels include, for example,those disclosed in U.S. Pat. Nos. 6,656,200, 5,874,500, 5,543,441,5,514,379, 5,410,016, 5,162,430, 5,324,775, 5,752,974, and 5,550,187.

The reaction conditions for forming crosslinked polymeric hydrogels fromfirst and second precursors may depend on the nature of the reactiveprecursor used as well as the surrounding environment. The first andsecond precursors may be stable and/or non-reactive at a given pH asthey are encased within oxidized cellulose and/or another biodegradablepolymer, but become reactive upon exposure the pH of the tissue pH. Inembodiments, reactions may be conducted in buffered aqueous solutions ata pH of about 5 to about 12. Buffers include, for example, sodium boratebuffer (pH 10) and triethanol amine buffer (pH 7). In some embodiments,organic solvents such as ethanol or isopropanol may be added to improvethe reaction speed of the first and second precursors.

In embodiments, the multi-encapsulated microspheres may incorporate anyother in situ polymerizable monomers suitable for forming biocompatibletissue implants, hydrogels and/or adhesives, such as α-cyanoacrylatemonomers, 1,1-disubstituted ethylene monomers, combinations thereof, andthe like.

Microspheres (e.g., single or multi-encapsulated microspheres) accordingto the present disclosure may also incorporate one or more magneticmaterials allowing for guidance of the encapsulated microspheres througha patient's body. Magnetic materials may be encapsulated into single ormulti-encapsulated microspheres using the methods and techniquesdescribed above with respect to bioactive agents. Multi-encapsulatedmicrospheres may include magnetic materials encapsulated therein alongwith bioactive agents, visualization agents, cross-linking precursors,radioactive materials, and combinations thereof, as discussed in moredetail below with respect to FIGS. 2, 3, 6, and 9. Multi-encapsulatedmicrospheres permit sequestration of magnetic materials from othersubstances (e.g., bioactive agents, visualization agents, etc.)contained in the microspheres, thereby allowing for magnetic guidance ofthe microspheres to the tissue site of interest as described in furtherdetail below.

Multi-encapsulated microspheres may be guided to a treatment site byinjecting or otherwise delivering the microspheres into the patient(e.g., intravenously, orally, etc.). After delivery of the microspheres,the treatment site is subjected to one or more magnetic fields, whichmay be generated by any suitable permanent or temporary magnets (e.g.,electromagnets). The magnetic fields retain the microspheres circulatingthrough the patient within the treatment site, i.e., the area to whichmagnetic field is applied. The microspheres thereafter begin tobiodegrade, delivering the materials encapsulated therein to thetreatment site. Magnetic guidance allows for the concentration ofbioactive agents at a predetermined target site, and away from othersites of the patient within healthy tissue.

Magnetic guidance provides for delivery of microspheres to specificlocations in the body which are hard to reach using conventionaldelivery mechanisms (e.g., catheters). Magnetic guidance is possiblewith more than one layer of encapsulation containing a magnetic payload,thus allowing for more than one occasion of magnetic guidance as thelayers erode and/or diffuse. The use of oxidized cellulose also lowersthe possibility of rusting of the magnetic payload (e.g., ironcontaining payload) since the process of encapsulation in oxidizedcellulose is an oil-in-oil process, i.e., a non-aqueous process.Magnetic Resonance Imaging (MRI) may also be facilitated with themagnetic materials. Complementary properties of more than one MRI agentcould be combined in the same formulation because of the multiple layersof encapsulation.

With reference to FIG. 2, the multi-encapsulating microsphere 20encapsulates a plurality of microspheres 22 therein. The microspheres 22include one or more bioactive agents, visualization agents, and/orcross-linking precursors described above. The multi-encapsulatingmicrosphere 20 further includes one or more magnetic materials.

With reference to FIG. 3, a doubly-encapsulating microsphere 30 includesa microsphere 32, which further encapsulates microsphere 34 as describedin more detail above. In one embodiment, the microsphere 30 may includea first bioactive agent, visualization agent, and/or cross-linkingprecursor described above. The microsphere 32 includes a secondbioactive agent, visualization agent, and/or cross-linking precursor.The microsphere 34 includes one or more magnetic materials.Encapsulation of the magnetic materials in the furthest encapsulatedmicrosphere 34, allows for the magnetic materials to remain at thetreatment site while doubly-encapsulating microsphere 30 degradesthereby releasing the first bioactive agent, visualization agent, and/orcross-linking precursor followed by the degradation of thesingle-encapsulating microsphere 34 thereby releasing the secondbioactive agent, visualization agent, and/or cross-linking precursor.

With reference to FIG. 6, multi-encapsulating microsphere 40 is shown.The microsphere 40 includes one or more first microspheres 42 and one ormore second microspheres 44. The first microspheres 42 may possess oneor more bioactive agents, visualization agents, and/or cross-linkingprecursors described above, and the second microspheres 44 include oneor more magnetic materials. Microspheres 42 and 44 may be encapsulatedin the same layer or in multiple layers, which may be the same ordifferent.

In embodiments, the microsphere 44 may also include magnetic materials,which allows for multiple opportunities of magnetic guidance. Inparticular, the microspheres 40 may be guided to a first treatment site,where the microsphere 40 degrades, thereby releasing the microspheres 42and 44. The microspheres 42 remain in place, thereby releasing payload,while the microspheres 44, which include magnetic materials may beguided to a second treatment site. The microspheres 44 may optionallyinclude a second bioactive agent, visualization agent, and/orcross-linking precursor described above. Once at the second treatmentsite, the microspheres 44 degrade thereby releasing its own payload.

With reference to FIG. 9, another embodiment a multi-encapsulatingmicrosphere 50 is shown. The microsphere 50 includes one or more firstmicrospheres 52, one or more second microspheres 54, and one or morethird microspheres 56. The first microspheres 52 may include one or morebioactive agents, the second microspheres 54 may include one or moremagnetic materials, and the third microspheres 56 may include avisualization agent, or any other suitable material. The firstmicrosphere 52, second microsphere 54, and third microsphere 56 may beformed separately prior to encapsulation within the microsphere 50.Microspheres 52, 54, 56 may be encapsulated in the same layer or inmultiple layers, which may be the same or different.

Where utilized, suitable magnetic materials may be in particle formhaving a size from about 10 angstroms (Å) to about 1000 Å, inembodiments from about 25 Å to about 500 Å. Suitable magnetic materialsmay be temporary magnetic materials or permanent magnetic materials,ceramic, crystalline, or flexible magnetic materials (e.g., a polymericsubstance such as thermoplastics or rubber) combined with magneticferrite (e.g., heat-treated mixtures of oxides of iron and one or moreother metals having complex crystals with magnetic properties). Suitablemagnetic materials include, but are not limited to, ferrite, strontiumferrous oxide, neodymium (NdFeB, optionally including dysprosium),samarium, cobalt, aluminum, nickel, copper, iron, titanium, andcombinations thereof. In embodiments, the microspheres 22 may includemagnetotactic bacteria having magnetosomes allowing the bacteria toorient within a magnetic field. In further embodiments, the magneticmaterial may be an alloy of a radioactive material such as yttrium-90,which is a β-emitter, making it suitable for radiation therapy treatmentof various cancers as described in further detail below.

Microspheres (e.g., single or multi-encapsulated microspheres) accordingto the present disclosure may also incorporate one or more radioactivematerials allowing the microspheres to be used in interventionaloncology (e.g., radiotherapy). Radioactive materials may be encapsulatedinto single or multi-encapsulated microspheres using the methods andtechniques described above with respect to bioactive agents. Suitableradioactive materials include, but are not limited to, yttrium (e.g.,⁹⁰Y), iodine (e.g., ¹³¹I), holmium (e.g., ¹⁶⁶Ho), combinations thereof,and the like. Microspheres containing radioactive materials may beformed by encapsulating the materials as described above. Inembodiments, radioactive materials may be encapsulated in oxidizedcellulose to form singly-encapsulated microspheres. In embodiments, theoxidized cellulose microspheres including radioactive materials may befurther encapsulated in successive oxidized cellulose microspheres.

Once microspheres are formed, they are subjected to neutron bombardmentprior to implantation within the patient to convert stable isotopes ofthe materials into radioactive materials suitable for radiotherapy(e.g., converting inert ⁸⁹Y into ⁹⁰Y). The microspheres may be guided tothe treatment site using any suitable methods (e.g., magnetic guidanceas described above if magnetic materials are present). The microspheresmay then deliver radiation therapy to the treatment site.

Neutron bombardment and/or other treatments may heat the microspheres upto 200° C., which causes degradation of many biodegradable polymers usedto create microspheres, such as polylactide. Accordingly, conventionalmicrospheres for delivering radioactive materials have been formed fromnon-biodegradable materials, such as glass. The present disclosureprovides for single or multi-encapsulated microspheres formed fromoxidized cellulose, which is a polymer capable of withstandingtemperatures up to 200° C. Unlike glass microspheres, the microspheresof the present disclosure provide for delivery of the radioactivematerials using biodegradable microspheres that degrade over time. Glassmicrospheres including radioactive materials are disclosed in S. Ho etal., “Clinical Evaluation Of The Partition Model For EstimatingRadiation Doses From Yttrium-90 Microspheres In The Treatment Of HepaticCancer Evaluation Of The Partition Model For Estimating Radiation DosesFrom Yttrium-90 Micro Spheres In The Treatment Of Hepatic Cancer,”European Journal of Nuclear Medicine, Vol. 24, No. 3, (March 1997), pp.293-298.

Microspheres made with oxidized cellulose are lower in density thanglass microspheres, which is an advantage for interventional oncologyapplications because high density microspheres result in intravascularsettling. With respect to conventional encapsulation materials, multipleencapsulation of radioactive materials using oxidized cellulose asdescribed herein prevents seepage and leakage of radioactive materialsfrom the microspheres.

Microspheres (e.g., single or multi-encapsulated microspheres) accordingto the present disclosure may also incorporate one or more endothermicor exothermic agents. Endothermic or exothermic agents may beencapsulated into single or multi-encapsulated microspheres using themethods and techniques described above with respect to bioactive agents.Endothermic and/or exothermic agents may be used in treatments whereexothermic and endothermic reactions (e.g., oncology) are desired,especially in an in situ setting, where the timing and anatomicallocation of such heat-producing or heat-absorbing reactions can becontrolled and manipulated to heat and/or cool tissue, respectively.Multi-encapsulated microspheres allow for control over timing andanatomical location of endothermic and/or exothermic reactions. In otherwords, the use of the multi-encapsulated oxidized cellulose formulationsallows control over the use of heat-produce or heat-removing reactions,as the reactants are compartmentalized. The actual production or removalof heat occurs only upon a breakdown of the encapsulating polymer, thusbringing the reactive components into contact as described in furtherdetail below.

Exothermic agents include a first exothermic reactant and a secondexothermic reactant. When the first and second reactants react heat isgenerated by the reaction into the surrounding tissue. Suitable firstand second exothermic reactants include, but are not limited to, acids,salts, water, calcium oxide, and combinations thereof.

Endothermic agents include a first endothermic reactant and a secondendothermic reactant. When the first and second reactants react heat iswithdrawn by the reaction from the surrounding tissue. Suitable firstand second endothermic reactants include, but are not limited to,ethanoic acid, sodium carbonate, calcium carbonate, and combinationsthereof.

Endothermic or exothermic reactants may be combined to produce anendothermic reaction, an exothermic reaction, or both, respectively.Suitable medical conditions for treatment with these endothermic and/orexothermic reactions include, for example, cancers (e.g., tumors),inflammation, infections, combinations, thereof, and the like. The useof oxidized cellulose for multiple-encapsulation of hydrophilicendothermic and/or exothermic reactants.

In embodiments, tumors may be treated by application of heat, whichdestroys cancer cells. There are two modes of heat application forcancer treatment: hyperthermia and thermoablation. Hyperthermia involvesheating of certain organs or tissues to temperatures from about 41° C.to about 48° C. Thermoablation generally involves heating tissues totemperatures from about 48° C. to about 56° C. Thermoablation ischaracterized by acute necrosis, coagulation, and/or carbonization ofthe tumor tissue due to the relatively higher temperatures involved.Heat is conventionally delivered by electrosurgical energy, resistiveheating, microwave energy, heated fluid, combinations thereof, and thelike. To compensate for the heat supplied to the tissue (e.g., limitheat application to the tumor) and prevent damage to surrounding healthytissue, heat sinks (e.g., circulated coolant) may be supplied to thesurrounding tissue and/or the device (e.g., catheter) being used duringablation.

In embodiments, the present disclosure provides for in situ delivery ofexothermic and/or endothermic reactants/agents via oxidized cellulosemicrospheres (e.g., multi-encapsulated formulations) within and outsidethe tumor, respectively. In embodiments, either one or both of theexothermic and endothermic agents may be delivered while heating and/orcooling is supplied or removed by other suitable methods (e.g., energyablation, coolant circulation, etc.).

With reference to FIG. 6, a multi-encapsulating microsphere 40 is shown,having one or more first microspheres 42 including a first endothermicor exothermic reactant and one or more second microspheres 44 includinga second endothermic or exothermic reactant. After implantation, themicrospheres 40, 42, and 44 prevent immediate reaction of the first andsecond endothermic or exothermic reactants. After degradation of themicrosphere 40, the microspheres 42 and 44 subsequently degrade, therebyreleasing the first and second endothermic or exothermic reactants,which then react in exothermic or endothermic fashion to heat or cooltissue as described above. In embodiments, the microsphere 40 may alsoinclude one or more initiators.

With reference to FIG. 10, the microspheres 40 possessing microspheres42 and 44 are implanted within and/or around the tissue region (e.g.,tumor T). In embodiments, exothermic microspheres 92, for example,microspheres 40 possessing microspheres 42 and 44 including first andsecond exothermic reactants, respectively, are implanted within thetumor boundary of the tumor T. Endothermic microspheres 90, namely,microspheres 40 possessing microspheres 42 and 44 including first andsecond endothermic reactants, respectively, are implanted on theperiphery of the tumor T with cooling of the surrounding tissue. Thisallows for enhanced heating within the tumor boundary and active coolingoutside the tumor boundary.

In embodiments, in situ exothermic and endothermic reactions may betimed along with initiation of thermal ablation in the tumor, such thatthe exothermic reaction within the tumor enhances the effect of thethermal ablation, while the endothermic reaction outside the tumorprotects the healthy tissue. In further embodiments, heating may beaccomplished using conventional hyperthermia or ablation devices, withmicrospheres 40, 42, and 44 being used to deliver endothermic reactantsaround the tissue to cool tissue. In further embodiments, cooling may beaccomplished using conventional cooling techniques, with microspheres 40being used to deliver exothermic reactants into the tissue to heattissue.

Microspheres (e.g., single or multi-encapsulated microspheres) accordingto the present disclosure may also incorporate one or more magneticmaterials allowing for guidance of the encapsulated microspherescontaining endothermic and/or exothermic reactants through a patient'sbody. Multi-encapsulated microspheres may be guided to a treatment siteby injecting or otherwise delivering the microspheres into the patient(e.g., intravenously, orally, etc.). After delivery of the microspheres,the treatment site is subjected to one or more magnetic fields, whichmay be generated by any suitable permanent or temporary magnets (e.g.,electromagnets). The magnetic fields retain the microspheres circulatingthrough the patient within the treatment site, i.e., the area to whichmagnetic field is applied. The microspheres thereafter begin tobiodegrade, delivering the materials encapsulated therein to thetreatment site. Magnetic guidance allows for the concentration ofendothermic or exothermic agents at a predetermined target site, andaway from other sites of the patient (e.g., reticular endothelialsystem).

In other embodiments, oxidized or modified cellulose microspheresaccording to the present disclosure may be used in embolizationprocedures, including those used in interventional oncology. Oxidizedcellulose's hemostatic properties make it useful in embolizationapplications, since the oxidized cellulose does not occlude thevasculature prior to contacting blood therein. In particular, oxidizedcellulose provides a superior mechanism for embolization thanconventional embolic agents, such as polyvinyl alcohol, which worksprimarily through mechanical action combined with inflammation andgranulation of surrounding tissue.

Embolization involves selective, e.g., either partial or full, occlusionof blood vessels to prevent blood flow to an organ, tumor, or any otherdesired segment of tissue. Vessel embolization may be used in a varietyof medical procedures including, but not limited to, controllingbleeding caused by trauma, prevention of profuse blood loss duringdissection of blood vessels, obliteration of an organ or a portionthereof, blocking of blood flow into abnormal blood vessels, and thelike. Embolization may be used to treat a variety of conditions bystopping or controlling blood flow including, but not limited to,hymoptysis, arteriovenous malformations, cerebral aneurysms,gastrointertinal bleeding, epistaxis, hemorrages, fibroids, lesions,and/or tumors. As used herein the term “embolization microsphere” refersto any particle formed from oxidized cellulose used to artificiallyblock any biological lumen including but not limited to, blood vessel,fallopian tubes, bile ducts, tear ducts, lymph ducts, vas deferens.

During use, the embolization microspheres may be implanted within theblood vessels using an implantation device, such as a catheter orsyringe, to access the blood vessels. Insertion of the implantationdevice may be guided using any suitable imaging techniques, such asdigital subtraction angiography, fluoroscopy, and the like. Once theimplantation device is at the treatment site, the embolizationmicrospheres are injected into the blood vessel to partially or fullyocclude the blood vessel thereby stopping or decreasing the blood flow.

As noted above, in embodiments microspheres of the present disclosuremay be used to disrupt blood flow to organs or tumors. With reference toFIG. 11, a tumor mass “T” is shown having one or more arterial bloodvessels “A” and venous blood vessels “V.” During embolization, aplurality of embolization microspheres 100 are implanted into thearterial blood vessel “A” using the implantation device (not shown). Theembolization microspheres may be suspended in an aqueous or alipid-based media to aid in storage and implantation. After embolizationmicrospheres are implanted, they are set in place within the bloodvessels and swell by absorbing surrounding fluids. Swelled microspheresocclude the blood flow within the blood vessels. Over time, theembolization microspheres hydrolyze and ultimately breakdown intoglucose and glucuronic acid, which are then metabolized within the body.

The embolization microspheres may be formed as single ormulti-encapsulated microspheres as described with respect to FIGS. 2, 3,6, and 9. The embolization microspheres may include one or more optionalbioactive agents useful in the embolization procedures, including, butnot limited to hemostatic agents, radioactive materials,chemotherapeutics, and combinations thereof.

In embodiments, the embolization microspheres may includeradio-protective materials to provide for protection from localradiation-based treatments as well as systemic sources of radiation.Suitable radio-protective material include, but are not limited to,Yttrium-90, Iodine-125, Iridium-192, Ruthenium-106, Cobalt-60,Palladium-103, Caesium-137, and combinations thereof. In furtherembodiments, embolization microspheres may be multi-encapsulatedmicrospheres as described with respect to FIGS. 3, 6, and 9 and mayinclude first encapsulated microspheres (e.g., microspheres 32, 42, 52)having a radio-protective material and second encapsulated microspheres(e.g., microspheres 34, 44, 54) having the radioactive materials. Thefirst microspheres may degrade at a faster degradation rate to dispersethe radio-protective material throughout the implantation site prior toradioactive material being dispersed from the second microspheres, whichlimits exposure of healthy tissue to radiation. In embodiments,microspheres containing the radio-protective materials may be implantedaround the tumor, similar to the microspheres 90 of FIG. 10, with themicrospheres containing the radioactive material, such as themicrospheres 92 of FIG. 10, being implanted within the tumor T.

Embolization microspheres may be formed according to any of theabove-described oil-in-oil emulsion solvent extraction processes, inwhich the solvent of the oxidized cellulose solution, NMP, is extractedby separation of two or more oils that are immiscible or insoluble withthe solvent, e.g., mineral and cottonseed oils. Suitable oils include,but are not limited to, petroleum-based oils, such as light, medium orheavy mineral oils (e.g., mixtures of alkanes having from about 40carbons to about 60 carbons), plant-based oils, such as cottonseed oil,silicone-based oils, and combinations thereof. In embodiments, two ormore oils may be a heavy oil and a light oil, that compete forextraction of the solvent. In embodiments, the heavy oil and the lightoil may be present at a ratio of from about 1:10 to about 10:1, inembodiments from about 1:3 to about 3:1.

Microspheres may be formed of any suitable size. In embodiments,microspheres may have a diameter from about 0.001 micrometers (μm) toabout 3,000 μm, in embodiments from about 0.1 μm to about 1,000 μm, infurther embodiments from about 10 μm to about 500 μm. The size, rate ofswellability, and rate of degradation of the embolization microspheresmay be controlled by adjusting the ratio and viscosity of the oils beingused in the solvent extraction process and the rate of stirring.Emulsion-based solvent extraction may be accomplished by stirring thesuspension or emulsion at a rate from about 25 rpm to about 60,000 rpm,in embodiments, from about 100 rpm to about 15,000 rpm, in furtherembodiments from about 250 rpm to about 5,000 rpm. The emulsion may bestirred for a period of time from about 5 seconds to about 4 hours, inembodiments, from about 15 seconds to about 1 hour.

As noted above, in embodiments the oxidized cellulose microspheresaccording to the present disclosure may be used as part of a liquidembolic composition. The liquid embolic composition may include a liquiddelivery vehicle, which may be a solution of a water-insoluble,biocompatible polymer dissolved in an organic solvent. Suitable polymersinclude ethylene vinyl alcohol, polyvinyl formal, polyvinylalcohol-vinyl formal, polyethylene vinyl formal, and combinationsthereof. Suitable solvents include any organic class 2 solvent asclassified by the International Conference on Harmonization that hasbeen approved for subcutaneous injection, such as NMP, dimethylsulfoxide, and combinations thereof. The embolization microspheres maybe any suitable type described above, e.g., multi-encapsulated. Inembodiments, the liquid delivery vehicle and/or the oxidized cellulosemicrospheres may include one or more optional visualization and/orbioactive agents useful in the embolization procedures, including, butnot limited to, hemostatic agents, radioactive materials,chemotherapeutics, and combinations thereof.

In embodiments, the liquid embolic composition may be provided as partof a kit. The kit may include a plurality of vials or other suitablecontainers for storing the liquid delivery vehicle, the embolizationmicrospheres, and one or more optional visualization and/or bioactiveagents (in addition to the ones included in the delivery vehicle and/orthe microspheres). The liquid embolic composition may be mixed prior todelivery by combining the contents of each of the vials pursuant toaccompanying instructions providing directions for formulating theliquid embolic composition.

The liquid embolic composition may include any suitable combination of aliquid delivery vehicle 101, embolization microspheres 102, and one ormore optional visualization 103 and/or bioactive agents 104 and 105 asshown in FIGS. 12-17. The liquid embolic composition may include thevisualization agent 103 within the liquid delivery vehicle 101 alongwith the microspheres 102 as shown in FIG. 12. In embodiments, thevisualization agent 103 may be included in the microspheres 102 as shownin FIG. 13. In embodiments, the microspheres 102 may include thebioactive agent 104 and the liquid delivery vehicle 101 may include thevisualization 103 agent as shown in FIG. 14. In further embodiments, themicrospheres 102 may include both the visualization agent 102 and thebioactive agent 103 (e.g., multi-encapsulated microspheres) as shown inFIG. 15. With reference to FIG. 16, the liquid delivery vehicle 101 mayinclude the bioactive agent 104 and the microspheres 102 may include thevisualization agent 103. In other embodiments, the liquid deliveryvehicle 101 may include the visualization agent 103 and the microspheres102 may include a plurality of bioactive agents 104 and 105 (e.g.,multi-encapsulated microspheres) as shown in FIG. 17.

The present disclosure also provides for an embolization slurryincluding oxidized cellulose. The term “slurry” as used herein refers toa fluid mixture including a mobile (e.g., liquid) phase and a solidphase. The solid phase may have solids present in an amount from about0.01% to about 60% by weight and/or volume of the slurry, in embodimentsfrom about 0.1% to about 25% by weight and/or volume of the slurry, infurther embodiments from about 1% to about 15% by weight and/or volumeof the slurry. The solid phase may be formed from any suitable oxidizedcellulose material, including fibers, microspheres, particulates,fragments, dissolved oxidized cellulose, oxidized cellulose suspension,oxidized cellulose emulsion, and combinations thereof.

In embodiments, the solid phase may include any suitable water solublepolymers including, but not limited to, polyethers, for example,polyalkylene oxides such as polyethylene glycol (“PEG”), polyethyleneoxide (“PEO”), polyethylene oxide-co-polypropylene oxide (“PPO”),co-polyethylene oxide block or random copolymers, and polyvinyl alcohol(“PVA”), poly(vinyl pyrrolidinone) (“PVP”), poly(amino acids),poly(saccharides) such as dextran, chitosan, alginates,carboxymethylcellulose, oxidized cellulose, hydroxyethylcellulose and/orhydroxymethylcellulose, hyaluronic acid, and proteins such as albumin,collagen, casein, and/or gelatin, and combinations thereof.

The liquid phase may include any suitable solvent that will suspend thesolid or dissolved oxidized cellulose material, including, but notlimited to, water, saline, serum, buffered aqueous solution(s), andcombinations thereof. The liquid phase may also include one or moreoptional bioactive agents useful in the embolization procedures,including, but not limited to hemostatic agents, radioactive materials,chemotherapeutics, visualization agents, radio-protective agents, andcombinations thereof.

In embodiments, the embolization slurry may be formed by contactingoxidized cellulose microspheres with the liquid phase (e.g., saline).The degradation rate of the oxidized cellulose within the slurry may beadjusted as described in further detail below (e.g., by adjusting thedegree of oxidation of the oxidized cellulose, the amount of residualsolvent in the oxidized cellulose microspheres, etc.). By controllingthe size and/or distribution of the polymer fibers of the oxidizedcellulose within the embolization slurry, non-targeted delivery of theembolization agent (e.g., oxidized cellulose) within the vasculature canbe minimized. In embodiments, the oxidized cellulose slurry may includeone or more optional visualization and/or bioactive agents useful in theembolization procedures, including, but not limited to, hemostaticagents, radioactive materials, chemotherapeutics, radio-protectiveagents, and combinations thereof.

During use, the embolization slurry may be implanted within the bloodvessels using an implantation device, such as a catheter or syringe, toaccess the blood vessels. Insertion of the implantation device may beguided using any suitable imaging technique, such as digital subtractionangiography, fluoroscopy, and the like. Once the implantation device isat the treatment site, the embolization slurry is injected into theblood vessel to partially or fully occlude the blood vessel, therebystopping or decreasing the blood flow.

The degradation rate of the embolization microspheres and theembolization slurry formed from oxidized cellulose may also becontrolled by adjusting the degree of oxidation of the oxidizedcellulose solution used to form the same. The degree of oxidation ofoxidized cellulose of the microspheres and/or the slurry may be fromabout 0.2 to about 0.8, in embodiments from about 0.3 to about 0.7. Thedegree of oxidation may be controlled during the dissolution process ofoxidized cellulose as described above.

The swellability rate may also be adjusted by crosslinking themicrospheres and the slurry before or after implantation within theblood vessels. Cross-linking of the microspheres and the slurry reducesthe swellability rate and the degradation rate of the microspheres andthe slurry, allowing the microspheres and the slurry to be disposedwithin the blood vessels for longer periods of time, as well as limitingthe swellable size of the microspheres. Suitable cross-linking agentsfor cross-linking embolization microspheres and the slurry may be any ofthe above-discussed cross-linking agents and include, but are notlimited to, a solution of multivalent cations (e.g., about 2% by weightaqueous solution of calcium chloride), chitosan (e.g., about 5% byweight solution of chitosan in acetic acid), carboxymethylcellulose,acrylic polymers, a Schiff-base compound, trilysine, albumin,polyethylene glycol amine, water, saline, phosphate buffered saline, andcombinations thereof. The cross-linking agent may be supplied to theimplantation site (e.g., blood vessel) after the embolizationmicrospheres or the slurry have been implanted to secure themicrospheres in place. In embodiments, the cross-linking agent may bemixed with the microspheres or the slurry prior to implantation,allowing the cross-linking agent to bind the oxidized cellulosefollowing implantation. In further embodiments, the oxidized cellulosesolution may include one or more bioactive agents, visualization agents,radioactive materials, and other payloads described herein allowing forvisualization and treatment of tumors and other tissues.

The embolization microspheres and the slurry according to the presentdisclosure provide a number of advantages over conventional embolizationparticles, which are formed from non-biodegradable materials (e.g.,non-resorbable polymers, glass, etc.). Oxidized cellulose and NMP havewell-established biocompatibility. In particular, oxidized cellulose isused in a variety of implantable medical devices approved by the U.S.Food and Drug Administration. NMP is a class 2 solvent as classified bythe International Conference on Harmonization and has been approved forsubcutaneous injection and other in situ uses (e.g., gel formation),which makes it well-suited for forming embolization microspheres. Inaddition to being biodegradable, the embolization microspheres and theslurry according to the present disclosure may have a tailoreddegradation, dissolution, and/or swellability rate. This allows forgreater control in occluding blood vessels and prevents damage tosurrounding tissue as the microspheres and the slurry fully degrade andonce again permit blood flow through the vessel in which they wereintroduced.

The rate of degradation may be adjusted by modifying the degree ofoxidation of the oxidized cellulose and the amount of the solventpresent in the oxidized cellulose solution. Adjustment of the degree ofoxidation affects the rate of biodegradation of the polymer back bone,eventually resulting in the dissolution of the microspheres and theslurry. Adjustments to the degree of oxidation affect medium tolong-term degradation profile of the microspheres and the slurry (e.g.,from about one day to several weeks). Adjustment of the amount ofsolvent affects the residual solvent remaining in the microspheres,which can be leveraged to control the rate of dissolution of thesemicrospheres over short-term (e.g. from about 30 seconds to about 12hours). The oxidized cellulose microspheres and the slurry according tothe present disclosure may have a degradation time from about 5 minutesto about 8 weeks, in embodiments from about 12 hours to about 2 weeks.The degree of oxidation of oxidized cellulose of the embolizationmicrospheres and the slurry in accordance with the present disclosuremay be from about 0.2 to about 1.0, in embodiments from about 0.3 toabout 0.9, in further embodiments from about 0.5 to about 0.7. Thesolvent may be present in an amount of from about 0.1% by weight to 25%by weight of the oxidized cellulose present in the microspheres and theslurry, in embodiments from about 0.5% by weight to about 10% by weightof the oxidized cellulose.

The adjustment to the degradation profile allows for use of theembolization microspheres according to the present disclosure intemporary or transient embolization procedures, which are rapidlyemerging as an attractive alternative to the more traditional permanentembolization approach for tumor treatment and other conditions. Oxidizedcellulose embolization microspheres and the slurry offer distinctadvantages, and significantly greater control than other embolizationtechnologies due to adjustable degradation, dissolution, and/orswellability rates since oxidized cellulose offers a wide spectrum interms of the kinetics of degradation as described above.

Embolization microspheres and the slurry formed from oxidized celluloseare also of lower density than conventional glass or othernon-biodegradable embolization beads, providing for betterdeliverability using conventional implantation devices. The process forforming microspheres according to the present disclosure also allows forformation of microspheres having varying size, shape,multi-encapsulation, and number of bioactive agents or other materialsencapsulated within the microspheres, by tailoring the formation processas described above.

Some currently available biodegradable embolization products utilizemicrospheres including PVA and, thus, are limited to delivery ofpositively charged or cationic bioactive agents, such as doxorubicin.Various other bioactive agents having either neutral charge (e.g.,paclitaxel), and those possessing a negative charge or anionic (e.g.siRNA therapeutics, i.e., small interfering RiboNucleicAcidtherapeutics) cannot be electrostatically entrapped by PVA, therebylimiting the use of PVA microspheres.

The present disclosure allows a variety of drugs to be loaded intooxidized cellulose based formulations at the time of use in an embolicprocedure. As oxidized cellulose has groups possessing a negative charge(e.g. carboxylic acid groups), it also has the potential for highloading of positively charged drug molecules without the need for anyadditional derivatization or functionalization.

In embodiments, embolization microspheres and/or the slurry formed fromoxidized cellulose may be loaded with bioactive agents at the time ofuse, e.g., in the operating room. This allows for the practitioner toselect any desired bioactive agent or combinations of bioactive agentsin forming the microspheres, which then may be used in variousprocedures. In addition, the rate of degradation of the oxidizedcellulose polymer may also be tailored (for example by changing thedegree of oxidation of the oxidized cellulose) in order to provide asuitable release rate of bioactive agents, e.g., sustained release,bolus release, or combinations thereof. Accordingly, the choice ofbioactive agents, their loading amount, as well as their release ratemay be customized for each patient and/or treatment when embolizationmicrospheres and/or the slurry are formed at the time of use.

Bioactive agent loading may be accomplished by combining preformedoxidized cellulose microspheres and/or the above-referenced slurry withone or more bioactive agents of choice. Loading may occur from about 1minute to about 3 hours prior to use, in embodiments from about 30minutes to about 1 hour prior to use. Oxidized cellulose microspheresand/or slurry may be preloaded with additional bioactive agents,visualization agents, cross-linking precursors, magnetic materials,radioactive materials, radio-protective materials, and combinationthereof.

As noted above, an oxidized cellulose slurry in accordance with thepresent disclosure may include oxidized cellulose fibers as well asparticulates. Because oxidized cellulose may be converted intoparticulate form, it offers the unique advantage of being used in amanner where both the polymer slurry form and the particulate form maybe used together, leveraging the advantages of both these physical formsof the oxidized cellulose polymers.

In embodiments, the oxidized cellulose may be modified to formderivatized oxidized cellulose that is particularly suited for specificcompounds, e.g., bioactive agents. This facilitates bioactive agentloading at the time of treatment, while at the same time offering theprospect of tunable sustained-release kinetics for the release of thebioactive agent. In embodiments, oxidized cellulose may be subjected tohydrophobic derivatization to allow the oxidized cellulose to chelatehydrophobic bioactive agents, e.g., paclitaxel. Hydrophobicderivatization may also include adding hydrophobic groups to thecellulose polymer backbone. Suitable hydrophobic groups which may beadded include, but are not limited to, alkanes, phenols, andcombinations thereof. In further embodiments, oxidized cellulose may becomplexed with chelation enhancers to enhance ionic interactions withcertain bioactive agents, for example, those which are metal-based (e.g.the cancer drugs cisplatin, carboplatin and/or oxaliplatin, which areplatinum based). Suitable chelation enhancers include, but are notlimited to, tripolyphosphates, sulfonates, and combinations thereof.Also included are macromolecular chelating agents, such as thosetargeting platinum.

In yet further embodiments, oxidized cellulose may be modified toprovide for affinity-based derivatization, such that the bioactive agent(e.g., antibody, receptor, etc.) is attached to the oxidized cellulosepolymer backbone, thus providing for affinity-based interaction. Inembodiments, serum proteins exhibiting strong affinity to anticancermetal drugs may be immobilized on oxidized cellulose polymers andprovide controlled release of the anticancer metal drugs. Suitableanticancer metal drugs include, but are not limited to, organometalliccomplexes of platinum, ruthenium, osmium, iridium, and combinationsthereof.

In additional embodiments, oxidized cellulose may be derivatized toinclude stimuli-responsive functional groups, such as those that respondto changes in pH, light, and/or other parameters. Suitable pH sensitivefunctional groups include, but are not limited to, carboxylic acids,primary, secondary or tertiary amines, their salts, and combinationsthereof. Suitable light sensitive functional groups include, but are notlimited to, azobenzene, pyrene, nitrobenzene, and combinations thereof.

The present disclosure also provides for a liquid embolization solutionincluding soluble oxidized cellulose in purely soluble form without anyinsoluble and/or particulate components. The embolization solutionaccording to the present disclosure may be used in embolizationprocedures, including those used in interventional oncology in a similarmanner as described above with respect to oxidized cellulosemicrospheres and oxidized cellulose slurry, which includes bothinsoluble and soluble components. The embolization solution provides foreffective embolization of a vessel while allowing for subsequentrecanalization of the vessel based on biodegradable properties of theoxidized cellulose as described in further detail below.

The embolization solution may include oxidized cellulose dissolvedaccording to the methods described above. Oxidized cellulose may bepresent in the solution in an amount from about 0.001% weight/volume(w/v) in the solution to about 45% w/v, in embodiments from about 1% w/vto about 30% w/v in the solution, in embodiments from about 5% w/v to25% w/v in the solution, in embodiments from about 10% w/v to about 20%w/v in the solution. Suitable solvents include any organic class 2 orclass 3 solvent as classified by the International Conference onHarmonization (ICH) that is considered safe for subcutaneous and/orintravenous injection within exposure limits determined by the ICH.Suitable solvents include, but are not limited to NMP, dimethylsulfoxide, and various other solvent options and combinations thereofincluding those solvents disclosed in “Guidance for Industry Q3C—Tablesand List,” published by U.S. Department of Health and Human ServicesFood, Drug Administration Center for Drug Evaluation and Research(CDER), and Center for Biologics Evaluation and Research (CBER), theentire contents of which is incorporated by reference herein. Since NMPis miscible with a wide range of solvents, both aqueous and organic, NMPoffers significant flexibility in the choice of the final solventsystem.

In embodiments, the oxidized cellulose solution may include one or moreoptional visualization and/or bioactive agents useful in theembolization procedures, including, but not limited to, bioactiveagents, visualization agents, radioactive materials, hemostatic agents,chemotherapeutics, radio-protective agents, and other payloads describedabove allowing for visualization and treatment of tumors and othertissues.

The oxidized cellulose embolization solution according to the presentdisclosure displays thixotropic properties at and above certain w/vconcentrations of the oxidized cellulose in the solution (e.g., fromabout 10% w/v to about 20% w/v in the solution)—a property which isbelieved to contribute to the ability of the soluble oxidized cellulosesolution to achieve effective embolization. As used herein the term“thixotropic” denotes decreasing viscosity of a composition in responseto physical strain (e.g. shaking, agitation) and increasing viscositywhen the composition is left undisturbed (i.e. under static conditions).

The thixotropic properties of the soluble oxidized cellulose also allowthe opportunity for a wider variety of therapeutic agents to be loadedinto the embolization solution, e.g., via physical entrapment in thehigh viscosity environment under static conditions, as compared toconventional embolic agents, e.g., poly-vinyl alcohol (PVA) polymerbased micro-particles, which primarily rely on electrostaticinteractions to encapsulate therapeutic agents.

During use, the embolization solution may be implanted within the bloodvessels using an implantation device, such as a catheter or syringe, toaccess the blood vessels. Insertion of the implantation device may beguided using any suitable imaging techniques, such as digitalsubtraction angiography, fluoroscopy, and the like. Once theimplantation device is at the treatment site, the embolization solutionis injected into the blood vessel to partially or fully occlude theblood vessel, thereby stopping or decreasing the blood flow. Oxidizedcellulose also has the ability to undergo significant swelling uponhydration, which is believed to contribute to its ability to achieveeffective embolization.

Recanalization time or time to recanalization (i.e., time afterblood-vessel occlusion to achieve re-establishment of blood flow)—whichdenotes the duration of the embolism—may also be customized based on theproperties of the oxidized cellulose to achieve desired embolizationduration. In embodiments, the recanalization time may be adjusted bymodifying the amount of the solvent in the solution. Recanalization timemay be proportional to the amount of oxidized cellulose present in theembolization solution. In embodiments, the recanalization time may befrom about 1 minute to permanent status, e.g., non-degradable. Infurther embodiments, the recanalization time may be from about 2 min toabout 6 months, in additional embodiments from about 5 min to 8 aboutweeks, in yet additional embodiments from about 5 min to about 6 weeks,and in yet further embodiments from about 10 min to about 4 weeks.

In embodiments, time to recanalization (i.e., time after blood-vesselocclusion to achieve re-establishment of blood flow) may also beadjusted by modifying the degradation rate of the oxidized cellulosepolymer—degradation of the polymer as driven by hydrolysis induced bywater molecules. The degradation rate of the oxidized cellulose may beadjusted by modifying the degree of oxidation and/or molecular weightdistribution of the oxidized cellulose used to form the embolizationsolution. The degree of oxidation of oxidized cellulose may be fromabout 0.2 to about 0.8, in embodiments from about 0.3 to about 0.7. Thedegree of oxidation may be controlled during the dissolution process ofoxidized cellulose as described above.

Customizable recanalization makes it possible to pursue embolizationapplications for a wide spectrum of embolization treatments that requiredifferent periods of recanalization. Rapid recanalization may be fromabout 5 minutes to about 24 hours and may be used to mitigate bleedingin the case of trauma patients, and for some interventional oncologyapplications including, but not limited to, trans-arterial embolization(TAE), trans-arterial chemo embolization (TACE), and radio-embolization.Medium term recanalization may be from about 1 hours to about 3 days andmay be used to perform uterine fibroid embolization (UFE) and in someinterventional oncology applications, e.g., TAE and TACE. Long termrecanalization may be from about 3 days to about 6 months and may beused to treat some UFEs and in some interventional oncologyapplications, e.g., TAE, TACE, and radio-embolization. Permanentembolization may be used in neurological interventional applicationsincluding, but not limited to, embolization treatments of brain tumors,aneurysms, and/or arterio-venous malformations (AVM).

In addition to controlling the recanalization time and therefore theduration of ischemia to the target tissue (e.g. a tumor), the ability tore-canalize embolized vessels in customizable windows of time alsoallows for multiple treatment of the same vessel and/or tissue regionrepeatedly (for e.g. with drug-loaded embolic agents). In contrast,permanent embolic agents may only be used once due to the permanentlyformed occlusion, and the opportunity for re-treatment of the vesseland/or target tissue is not possible.

Oxidized cellulose includes several properties, which make it useful asan embolization agent. Oxidized cellulose has hemostatic properties,which provide more effective blood-vessel occlusion and thereforeembolization and does not induce extensive inflammation or granulation.This combination of properties, namely, hemostatic without beinginflammatory, provides a superior targeted mechanism of action withminimal inflammation and tissue granulation in comparison to existingembolic agents such as PVA microparticles, which primarily operatethrough the inducement of inflammation and granulation of tissue.

In comparison to other conventional embolization materials/compositionsavailable in liquid form, the liquid oxidized cellulose embolizationsolution according to the present disclosure provides a number ofadvantages. As noted above, oxidized cellulose may be used to provide anon-permanent, biodegradable embolization as compared with permanentembolization compositions such as cyanoacrylates or ethylene vinylalcohol copolymers. In particular, oxidized cellulose does not sufferfrom the disadvantages of cyanoacrylates, which have a high risk ofnon-targeted embolization due to inadvertent and/or non-targeted contactwith ionic fluids. Moreover, no other liquid embolic agents offer theability to tailor the time to recanalization, as provided by the liquidoxidized cellulose embolization solution according to the presentdisclosure. Oxidized cellulose also does not require temperaturemanipulation as required by conventional liquid embolic agents, whichrely on a solution-to-gel transition.

Moreover, oxidized cellulose is highly biocompatible due to lack ofextensive polymer-induced inflammation or granulation, which is asignificant advantage in embolic applications, especially when temporaryembolization is desired. The biocompatibility of oxidized cellulose alsoprovides better outcomes when the occlusion has been dissolved andexpeditious healing of the vasculature is desired.

In comparison to other conventional embolization materials and/orcompositions available in particulate and/or insoluble form, a liquidoxidized cellulose embolization solution according to the presentdisclosure provides important advantages, e.g., improved penetration ofvessels, complete filling of embolization targets, improved ability toflow through complex vascular structures, and adjustable viscosity.Viscosity of the embolization solution may also be modified by adjustingthe concentration of the soluble oxidized cellulose, namely, modifyingthe weight/volume ratio of the oxidized cellulose in solution. Inembodiments, the embolization solution may be formed just prior toinjection to achieve an embolization solution having desired properties.This may include, but is not limited to, adjusting the amount ofoxidized cellulose, loading various therapeutic agents described above,and adjusting the dosage of the therapeutic agents.

The liquid oxidized cellulose embolization solution according to thepresent disclosure is also useful in preventing non-targeted particulateembolization. Since the embolization solution only includes solubleoxidized cellulose, non-targeted delivery of any insoluble orparticulate embolic agent within the vasculature is avoided. Thisprovides an advantage over any polymer particulate or microsphereembolization agents, which may result in inadvertent delivery ofembolization particles to non-targeted vessels.

Another advantage of the liquid oxidized cellulose embolization solutionis its ability to achieve recanalization of vessels based onhydrolysis-driven biodegradation rather than enzymatic degradation ofstarch-based embolic solutions. A hydrolysis-driven biodegradationprocess is advantageous over enzymatic biodegradation processes since itprovides greater control over the degradation rate (e.g. by controllingdegree of oxidation of the polymer), as well as a lack of dependence onthe presence of endogenous or exogenous enzymes to inducebiodegradation.

The advantages of the liquid oxidized cellulose embolization solutionaccording to the present disclosure are believed to be due, in part, tothe distinct mechanism of phase transition for soluble oxidizedcellulose, driven by its hemostatic, thixotropic and swellingproperties, ability to load a wide variety of therapeutic molecules, aswell as the rate of degradation of oxidized cellulose being amenable tomodulation by adjustments to the degree of oxidation and the molecularweight distribution of oxidized cellulose. Thus, the liquid oxidizedcellulose embolization solution provides an effective liquid andbiodegradable embolic agent due to a combination of its uniqueproperties, especially when employed in combination, for embolizationapplications, as described above.

It should be appreciated that the above-described embodiments of themulti-encapsulated microspheres and embolization compositions are merelyillustrative and various additional combinations of multi-encapsulatedmicrospheres, bioactive agents, visualization agents, cross-linkingprecursors, magnetic materials, radioactive materials, radio-protectivematerials and the like may be used in combination and/or interchangeablytherewith. The option of pursuing multi-encapsulated formulations withdisparately, e.g., more than one kind of, derivatized oxidized cellulosepresents the advantage of combining more disparate therapeutic agentsloaded into the formulations.

The following Examples are being submitted to illustrate embodiments ofthe present disclosure. These Examples are intended to be illustrativeonly and are not intended to limit the scope of the present disclosure.Also, parts and percentages are by weight unless otherwise indicated. Asused herein, “room temperature” or “ambient temperature” refers to atemperature from about 20° C. to about 25° C.

EXAMPLES Comparative Example 1

This Example describes incomplete dissolution of oxidized cellulosehaving a degree of oxidation of 0.6 in a solution including 8% by weightlithium chloride (LiCl) and N-methyl-2-N,N-Dimethylacetamide (DMAc).

About 1.6 grams (g) of LiCl was first dissolved in about 20 milliliters(mL) DMAc to form an 8% LiCl in DMAc solution. About 20 milliliters (mL)of the 8% LiCl in DMAc solution was added to a reactor vessel, and washeated to about 160° C. under argon. About 149 milligrams (mg) ofoxidized cellulose having a degree of oxidation of 0.6 was added to thereactor vessel. The mixture was heated for about 1.17 hours, cooled toambient temperature, and discharged from the reactor vessel. The sampledid not fully dissolve, and was observed to discolor significantly,indicating that further oxidation of the oxidized cellulose hadoccurred.

Comparative Example 2

This Example describes incomplete dissolution of oxidized cellulosehaving a degree of oxidation of 0.6 in 8% by weight of LiCl in DMAcsolution.

About 20 mL of the 8% LiCl in DMAc solution produced above inComparative Example 1 and about 90 mg of oxidized cellulose having adegree of oxidation of 0.6 were added to a reactor vessel. The mixturewas heated to about 150° C. under argon for about 5.3 hours, cooled toambient temperature, and discharged from the reactor vessel. The sampledid not fully dissolve, and was observed to discolor significantly,indicating further oxidation of the oxidized cellulose occurred.

Comparative Example 3

This Example describes pretreatment of oxidized cellulose having adegree of oxidation of 0.6 in water.

About 22 mg of oxidized cellulose having a degree of oxidation of 0.6was placed in a reactor vessel and about 0.66 grams of deionized waterwas added thereto. The mixture was stirred for a period of time fromabout 2 minutes to about 3 minutes. The water was then removed in avacuum, and about 20 mL of the 8% LiCl in DMAc solution from ComparativeExample 1 was added to a reactor vessel. The mixture was heated to about155° C. for about 4.6 hours. It was then cooled to ambient temperature,and discharged from the reactor vessel. The sample did not fullydissolve. Thus, pretreatment of the oxidized cellulose in water had nodiscernable effect on dissolution.

Comparative Example 4

This Example describes dissolution of cellulose in a solution including1% by weight of LiCl in N-methyl-2-pyrrolidinone (NMP) under inertatmosphere.

About 20 mL of the NMP and approximately 80 mg of non-modified cellulosewere added to a reactor vessel. The mixture was heated to about 150° C.under argon for about 6 hours and then cooled to about 110° C. afterwhich approximately 0.2 g of LiCl was added to the reactor vessel. Thereactor vessel was maintained at about 110° C. for an additional hourbefore being cooled to about 80° C. The reactor vessel was maintained atabout 80° C. for about 14.5 hours after which it was observed that thesample had not dissolved and that pieces of non-modified cellulose wereobserved in the reactor vessel indicating that 1% LiCl NMP solution didnot completely dissolve cellulose.

Example 1

This Example describes dissolution of oxidized cellulose having a degreeof oxidation of 0.6 in a solution including 1% by weight of LiCl inN-methyl-2-pyrrolidinone (NMP).

A 100 mL three-neck round-bottom flask was used as a reactor vessel andwas fitted with a gas inlet, a mechanical stirrer, and a gas outlet,which was then connected to a flow rate monitor. The flask was purgedwith argon for about 5 minutes at a rate of approximately 0.4 liter perminute (L/min), which was measured as approximately 5 bubbles per secondby the flow rate monitor.

About 20 mL of anhydrous NMP was pipetted into the flask, which was thenagain purged with argon. Argon flow was adjusted to a rate ofapproximately 0.2 L/min or from about 2 bubbles per second to about 3bubbles per second, as observed on the flow rate monitor.

A helium line was attached to the flask and the argon flow was stopped.The helium line was inserted into the reactor and submerged below theliquid level, and the helium flow was set at approximately 0.2 L/min tosparge the NMP. After about 45 minutes of sparging, the helium line wasremoved and the argon flow was reinitiated at a rate of about 0.2 L/min.

About 80 mg of oxidized cellulose having a degree of oxidation of 0.6was cut into approximately 0.5 cm×0.5 cm square pieces. Argon flow wastemporarily increased to about 0.4 L/min and the oxidized cellulose wasadded to the flask, after which the argon flow was restored to about 0.2L/min.

The mixture was stirred at about 200 revolutions per minute (rpm). Theflask was heated from about 130° C. to about 135° C. using atemperature-controlled heating mantle. The temperature was maintainedfor about 2 hours under argon as the mixture was stirred. Thereafter,the mixture was cooled to a temperature from about 100° C. to about 110°C.

A scintillation vial was purged with argon in preparation for additionof LiCl. About 0.2 grams of anhydrous LiCl was weighed in the vial.Stirring was temporarily suspended and argon flow was increased to about0.4 L/min while the LiCl was added to the reactor vessel. After additionof the LiCl, the argon flow was restored to about 0.2 L/min. Stirringwas resumed at about 450 rpm for about 5 minutes and then reduced toabout 200 rpm.

Temperature was maintained from about 100° C. to about 110° C. Themixture was visually inspected approximately 5 minutes after addition ofthe LiCl and about every 15 minutes thereafter to determine whetheroxidized cellulose was dissolved. The oxidized cellulose was observed tohave undergone complete dissolution. Heating was terminated and thesolution was cooled to ambient temperature and stirred at about 200 rpm.The solution was then transferred into a scintillation vial under argonand sealed. The solution was stored at ambient conditions.

Example 2

This Example describes dissolution of oxidized cellulose having a degreeof oxidation of 0.6 in a solution including 1% by weight of LiCl in NMPunder ambient atmosphere.

The same process was followed as set forth in Example 1 above, exceptthe dissolution was carried out under ambient atmosphere. Oxidizedcellulose was observed to have undergone complete dissolution.

Example 3

This Example describes dissolution of oxidized cellulose having a degreeof oxidation of 0.6 in a solution including 1% by weight of LiCl in NMPunder ambient atmosphere without helium sparging.

The same process was followed as set forth in Example 1 above, exceptthe dissolution was carried out under ambient atmosphere and withouthelium sparging. Oxidized cellulose was observed to have undergonecomplete dissolution.

Molecular weight was determined for the dissolved oxidized cellulose ofExamples 1-3 as summarized in Table 1 below.

TABLE 1 Example Mn (g/mol) 1 2.7 × 10{circumflex over ( )}5 2 1.4 ×10{circumflex over ( )}5 3 1.8 × 10{circumflex over ( )}5

As illustrated in Table 1, dissolved oxidized cellulose of Example 1 hadthe highest molecular weight, whereas the dissolved oxidized celluloseof Examples 2 and 3 had a much lower molecular weight. Without beingbound by any particular theory, it is believed that conductingdissolution under ambient atmosphere degrades the oxidized cellulose,resulting in lower molecular weight.

Example 4

This Example describes the dissolution of non-modified cellulose in 8%by weight on LiCl in NMP solution and analysis of the dissolved oxidizedcellulose of Example 1, the non-modified cellulose of this Example, anda pullalan standard sample using gel permeation chromatography (GPC).

The same process was followed as set forth in Example 1 above, exceptabout 80 mg of non-modified cellulose was dissolved, the mixture of thenon-modified cellulose and the solvent was heated from about 145° C. toabout 155° C., and about 1.6 grams of anhydrous LiCl was added to themixture to achieve 8% by weight LiCl in NMP solution since 1% LiClsolution was ineffective as illustrated in Comparative Example 4.Further, after addition of LiCl, the temperature was maintained fromabout 100° C. to about 110° C. for at least one hour. The non-modifiedcellulose was observed to have undergone complete dissolution.

Samples of the dissolved oxidized cellulose of Example 1, thenon-modified cellulose of this Example, and the pullalan standard samplewere then analyzed using GPC. A mobile phase of 1% by weight of LiCl inNMP Solution for GPC was prepared. About 1.5 liters (L) of NMP was addedto a 2 L volumetric flask, which was then loosely capped with a glassstopper. NMP was stirred. About 20 grams of LiCl was added to the NMPand was stirred for about 60 minutes until it was dissolved. About 0.5 Lof NMP was added to the 2 liter mark and stirring was stopped.Additional NMP was added to the mark and the solution was mixed byhand-inverting. A 1 micron polytetrafluoroethylene (PTFE) filtermembrane was placed in a filtration apparatus and a vacuum was applied,which enabled the LiCl in NMP solution to flow through the membrane,thereby filtering the solution. The mobile phase solution was stored atambient conditions.

Samples of the dissolved oxidized cellulose of Example 1, thenon-modified cellulose of Example 4, and a pullalan standard sample wereseparately filtered through a 1 micron PTFE filter membrane into 3separate high-performance liquid chromatography (HPLC) vials. Inaddition, a combined sample was also prepared by combining about 500microliters (μL) of the dissolved oxidized cellulose of Example 1 andabout 500 μL of the pullalan standard sample (at a concentration ofabout 2 mg/mL) in a single HPLC vial.

All of the samples were subjected to GPC analysis performed using a gelpermeation chromatography system with two 300 millimeter (mm)×7.5 mmcolumns of Polymer Laboratories' PLGEL™ in a series configuration. ADAWN® HELEOS™ II multi-angle laser light scattering system from (WyattTechnology of Santa Barbara, Calif.) was used for absolute molecularweight determination. A refractive index model number OPTILAB® rEX inconjunction with the light scattering detector supplied by WyattTechnology was also used during molecular weight analysis.

GPC was performed at a flow rate of about 1 mL per minute, at atemperature of about 50° C., with an injection volume of about 100 μL.GPC chromatograms of the oxidized cellulose of Example 1 and thenon-modified cellulose of Example 4 are shown in FIGS. 18 and 19,respectively.

Example 5

This Example describes dissolution of oxidized cellulose having a degreeof oxidation of 0.39 in 8% by weight of LiCl in DMAc solution.

About 20 mL of DMAc was added to a reactor vessel under argon, followedby sparging thereof for approximately 10 minutes with helium. About 19mg of oxidized cellulose having a degree of oxidation of 0.39 was addedto the reactor vessel, which was initially heated to about 144° C. Afteraddition of the oxidized cellulose, the temperature was increased toabout 152° C. for approximately 3.2 hours. The reactor vessel was thencooled to about 95° C. and about 1.6 grams of LiCl was added to themixture to form an 8% LiCl in DMAc solution. The mixture was then heatedto about 95° C. for about 45 minutes, then cooled to ambienttemperature. The solution was stirred at ambient temperature forapproximately 64 hours, and discharged from the reactor vessel. Theoxidized cellulose was observed to have undergone complete dissolution.

Example 6

This Example describes dissolution of oxidized cellulose having a degreeof oxidation of 0.39 in a solution including 8.8% by weight of LiCl inNMP.

About 20 mL of NMP was added to the reactor vessel under argon followedby sparging thereof for approximately 1 hour with helium. About 10.2 mgof oxidized cellulose having a degree of oxidation of about 0.39 wasadded to the reactor vessel, which was initially heated to a temperaturefrom about 148° C. to about 154° C. for approximately 2.5 hours. Thereactor vessel was then cooled to about 103° C. and about 1.77 grams ofLiCl was added to the mixture to form an 8.8% LiCl in NMP solution. Themixture was then heated to a temperature from about 103° C. to about105° C. for about 1 hour, then cooled to ambient temperature. Thesolution was stirred at ambient temperature for approximately 24 hours,and discharged from the reactor vessel. The oxidized cellulose wasobserved to have undergone complete dissolution.

Example 7

This Example describes dissolution of oxidized cellulose having a degreeof oxidation of 0.39 in a solution including 1% by weight of LiCl inNMP.

About 20 mL of NMP was added to the reactor vessel under argon followedby sparging thereof for approximately 1 hour with helium. About 11 mg ofoxidized cellulose having a degree of oxidation of about 0.39 was addedto the reactor vessel, which was initially heated to a temperature fromabout 143° C. to about 148° C. for approximately 2 hours. The reactorvessel was then cooled to about 100° C. and about 0.20 grams of LiCl wasadded to the mixture to form a 1% LiCl in NMP solution. The mixture wasthen heated to about 93° C. for about 8 minutes, then cooled to ambienttemperature. The solution was stirred at ambient temperature forapproximately 24 hours, and discharged from the reactor vessel. Theoxidized cellulose was observed to have undergone complete dissolution.

Example 8

This Example describes formation of oxidized cellulose microspheres froman oxidized cellulose solution including 1% by weight of LiCl inN-methyl-2-pyrrolidinone (NMP).

A 600 mL glass beaker was set on a ring stand. A constant-torque mixerwas fitted with a medium-shear impeller, which was inserted into thebeaker. Approximately 200 mL of heavy white mineral oil was added to thebeaker with the mixer set to rotate at approximately 1,500 rpm. About1.7 grams of oxidized cellulose solution (about 15% by weight/volume ofoxidized cellulose in NMP) was added drop-wise to the vortex of thestirring mineral oil for about 15 minutes until all of the solution wasadded to the oil to form an emulsion including a plurality of oxidizedcellulose microspheres.

About 150 mL of isopropyl myristate was added to the emulsion and themixer speed reduced to approximately 900 rpm and maintained for about 45minutes. Thereafter, another 150 mL of isopropyl myristate was added tothe emulsion such that isopropyl myristate was present at a ratio to theoil of about 3:2 and rotations were reduced to approximately 600 rpm.

The emulsion was stirred from about 2 hours to about 3 hours to extractthe NMP from the oxidized cellulose microspheres. After NMP wasextracted, microspheres were collected by filtration. The microsphereswere then washed with a sufficient volume of n-heptane to remove anytrace of processing oils on the surface of the microspheres. Themicrospheres were dried for about 24 hours. Collected microspheres shownin FIGS. 20A-B were imaged using a Zeiss Leo 435, scanning electronmicroscope (SEM) at about 100× and 250×, respectively. The SEM imagesshow microspheres having a spherical shape and a smooth outer surface.

Example 9

This Example describes formation of 18% by weight (theoretical loading)vitamin B-12 loaded oxidized cellulose microparticles, from a 15% byweight/volume oxidized cellulose solution including 1% by weight of LiClin N-methyl-2-pyrrolidinone (NMP).

A discontinuous phase was prepared from the oxidized cellulose solutionof Example 1. About 3 grams of the oxidized cellulose solution (about15% by weight/volume of oxidized cellulose in NMP) was combined withapproximately 100 milligrams of cyanocobalmin (vitamin B-12).

A 1 liter glass beaker was set on a ring stand. A constant-torque mixerwas fitted with a medium-shear impeller, which was inserted into thebeaker. Approximately 300 mL of heavy white mineral oil was added to thebeaker with the mixer set to rotate at approximately 550 rpm. Thesolution of cyanocobalmin and oxidized cellulose was then addeddrop-wise to the vortex of the stirring mineral oil for about 15 minutesuntil all of the solution was added to the oil to form an emulsion.

About 300 mL of cottonseed oil was added to the emulsion. The emulsionwas stirred at approximately 900 rpm for about 60 minutes. Thereafter,another 300 mL of cottonseed oil was added to the emulsion. The emulsionwas again stirred at approximately 900 rpm for about 60 minutes. About100 mL of n-heptane was added to the emulsion.

The emulsion was stirred for about 60 minutes to extract the NMP fromthe oxidized cellulose microparticles. After NMP was extracted,microparticles were collected by filtration. The microparticles werethen washed with a sufficient volume of n-heptane to remove any trace ofprocessing oils on the surface of the microparticles. The microparticleswere dried for about 24 hours.

Collected microparticles were imaged using a Zeiss Leo 435 SEM, whichare shown in FIGS. 21A-B at about 500×, and 1100×, respectively. The SEMimages show microparticles having a textured surface with somemicroparticles having an elongated, rod-like shape and others having asphere-like shape. Without being bound by any particular theory, it isbelieved that smooth, spherical structure of the microparticles iscaused by hydrophilic nature of B-12.

Example 10

This Example describes formation of 40% by weight (theoretical loading)bupivacaine free base loaded oxidized cellulose microparticles, from a15% by weight/volume oxidized cellulose solution including 1% by weightof LiCl in N-methyl-2-pyrrolidinone (NMP).

The same process was followed as set forth in Example 9 above, exceptabout 253.5 milligrams of bupivacaine free base was added to theoxidized cellulose solution.

Collected microparticles were imaged using a Zeiss Leo 435 SEM, whichare shown in FIGS. 22A-B at about 50× and 250×, respectively. The SEMimages show microparticles having a spherical shape and a texturedsurface. Without being bound by any particular theory, it is believedthat the rougher surface is caused by the wrapping of the crystals ofbupivacaine free base, which is hydrophobic, within the oxidizedcellulose microparticles.

Example 11

This Example describes formation of 40% by weight (theoretical loading)bupivacaine HCl loaded oxidized cellulose microparticles, from a 15% byweight/volume oxidized cellulose solution including 1% by weight of LiClin N-methyl-2-pyrrolidinone (NMP).

The same process was followed as set forth in Example 9 above, exceptabout 250.2 milligrams of bupivacaine HCl was added to the oxidizedcellulose solution.

Collected microparticles were imaged using a Zeiss Leo 435 SEM, whichare shown in FIGS. 23A-B at about 50× and 250×, respectively. The SEMimages show microsparticles having an irregular, crystalline shape and atextured surface. Without being bound by any particular theory, it isbelieved that structure of the microparticles is caused by theneedle-like crystalline nature of bupivacaine HCl, which hydrophilic.

Example 12

This Example describes formation of 30% (theoretical and actualmeasurement) by weight vitamin B-12 loaded oxidized cellulosemicrospheres, from a 15% by weight/volume oxidized cellulose solutionincluding 1% by weight of LiCl in N-methyl-2-pyrrolidinone (NMP).

The same process was followed as set forth in Example 9 above, exceptabout 200 milligrams of cyanocobalmin (vitamin B-12) was added to theoxidized cellulose solution.

Collected microparticles were imaged using a Zeiss Leo 435 SEM, whichare shown in FIGS. 25A-B at about 1,000× and 1,700×, respectively. TheSEM images show microspheres having a substantially spherical shape anda smooth outer surface.

Actual loading of the 30% B-12 loaded microspheres was determined usinga SpectraMax M2, a UV-Vis spectrophotometer. Approximately 1 mg of B-12was dissolved in about 10 mL of water and scanned from about 200 nm toabout 800 nm in order to determine maximum absorbance. Maximumabsorbance was measured at approximately 358 nm. A stock solution wasmade with about 10 mg B-12 in 200 mL of water. From this stock solution,serial dilutions were made and a five (5) point standard calibrationcurve was constructed as shown in FIG. 24. About 2.55 mg of the 30% B-12loaded microspheres was dissolved in 10 mL water, then further dilutedto achieve a ratio of microspheres to water of about 1:2. The dilutedsolution was analyzed and measured at an absorbance concentration ofapproximately 0.679 as shown in Table 2 below. Actual loading of vitaminB-12 was measured to be about 31%.

TABLE 2 Sample Conc, Total Weights, Absorbance mg/mL amt., mg % API mgVitamin B12 0.679 0.04 0.79 31.0 2.55 oxidized cellulose microspheres

Example 13

This Example describes formation of 25% by weight (theoretical loading)vitamin B-12 loaded oxidized cellulose microspheres from a 15% byweight/volume oxidized cellulose solution including 1% by weight of LiClin N-methyl-2-pyrrolidinone (NMP).

The same process was followed as set forth in Example 9 above, exceptabout 150 milligrams of vitamin B-12 was added to the oxidized cellulosesolution.

Collected microparticles were imaged using Keyence VHX-600, a lightmicroscope, which are shown in FIGS. 26A-B at about 600× and 1,000×,respectively. The images show microspheres having a substantiallyspherical shape.

Example 14

This Example describes formation of poly-D,L,-lactide (PDLLA)microspheres encapsulating cis-diamminedichloroplatinum(II) (CDDP)loaded oxidized cellulose microspheres.

A 1 liter glass beaker was set on a ring stand. A constant-torque mixerwas fitted with a medium-shear impeller, which was inserted into thebeaker. Approximately 200 mL of heavy white mineral oil was added to thebeaker with the mixer set to rotate at approximately 1,800 rpm.

About 300 milligrams of CDDP was added to about 3 grams of the oxidizedcellulose solution having a concentration of about 15 mg/mL, whichformed a gel. The gel was vortexed for about 30 seconds until a uniformconsistency was achieved and no particles of CDDP were visible.

The gel of CDDP and oxidized cellulose was then added drop-wise to thevortex of the stirring cottonseed and mineral oils for about 15 minutesat about 1,800 rpm, until all of the solution was added to the oil toform an emulsion.

About 200 mL of cottonseed oil were added to the emulsion and the mixingspeed was reduced to about 700 rpm after approximately 1 minute. Afterabout 30 minutes, approximately 200 mL of cottonseed oil was added alongwith about 50 mL of n-heptane and the emulsion was mixed forapproximately 2.5 hours to extract the NMP from the oxidized cellulosemicrospheres. After the NMP was extracted, microspheres were collectedunder vacuum by filtration through Whatman No. 4 filter paper. Themicrospheres were then washed with a sufficient volume of n-heptane toremove any trace of processing oils on the surface of the microspheres.

Collected microspheres were imaged using Keyence VHX-600, a lightmicroscope, which are shown in FIG. 27 at about 1,000×. The light imagesshow microspheres having a substantially spherical shape and a smoothsurface. The microspheres were of yellow color showing CDDPencapsulation.

A 4 liter glass beaker was set on a ring stand and the mixer was fittedwith a high-shear radial impeller above a medium-shear bottom impeller.About 2,500 mL of 1% polyvinyl alcohol (PVA) in water was added to thebeaker and the mixing speed was set to about 1,800 rpm. A solutionhaving a concentration of about 200 mg/mL of PDLLA was prepared bydissolving about 1 gram of PDLLA in about 5 mL of dichloromethane. TheCDDP/oxidized cellulose microspheres were then added to the PDLLAsolution and vortexed to ensure a uniform distribution of themicrospheres in the PDLLA solution thereby forming a suspension.

The suspension was then added to the PVA solution. Mixing was maintainedat about 1,810 rpm for about 5 minutes after which, the speed wasreduced to about 1,150 rpm for about 60 minutes. About 500 mL ofdistilled water was then added to the emulsion to extractdichloromethane from the multi-encapsulated microspheres, namely, PDLLAmicrospheres encapsulating the CDDP/oxidized cellulose microsphere. Themulti-encapsulated microspheres were harvested after about 2.5 hours ofmixing. The microspheres were washed with distilled water to remove alltraces of the PVA. They were then collected off each sieve byfiltration. The collected microspheres were then air-dried for about 24hours.

Collected microspheres were imaged using Keyence VHX-600, a lightmicroscope, which are shown in FIG. 28 at about 1,000×. Microsphereswere also embedded in epoxy and a cross-sectional slice of thereof wasobtained, which was then imaged using a FEI Quanta 600 FEG SEM, which isshown in FIG. 29 at about 1,475×. The images of FIGS. 28 and 29 showlarger PDLLA microspheres encapsulating a plurality of oxidizedcellulose microspheres, which were observed to be gold in color (FIG.28), which in turn, encapsulate CDDP, which were observed to be red incolor (FIG. 29).

CDDP, a water-soluble compound, was successfully encapsulated inmicrospheres formed from solubilized oxidized cellulose using anoil-in-oil (o/o), solvent extraction method. These microspheres werethen encapsulated in polylactide microspheres, using asolid-in-oil-in-water modified emulsion, solvent extraction (MESE)method. The “microsphere(s)-in-a-microsphere” particles werefree-flowing and easily handled, no fragility was observed. Since CDDPencapsulation was conducted without water, sodium chloride was notrequired, which is used when aqueous systems are employed inencapsulating CDDP to prevent transforming the cis form of CDDP intotrans, which is has diminishing bioactive effect.

Example 15

This Example describes formation of 8.2% by weight ferrous gluconateloaded oxidized cellulose microspheres from a 15% by weight/volumeoxidized cellulose solution including 1% by weight of LiCl inN-methyl-2-pyrrolidinone (NMP).

The same process was followed as set forth in Example 9 above, exceptabout 100 milligrams of ferrous gluconate was added to the oxidizedcellulose solution.

Collected microparticles were collected on a glass slide and imagedusing an Olympus SZX16, a light microscope, which are shown in FIG. 30at about 40×. The images show microspheres having a substantiallyspherical shape and measuring about 100 μm in diameter.

Example 16

This Example describes formation of iodine contrast agent loadedoxidized cellulose microspheres from a 13% by weight/volume oxidizedcellulose solution including 1% by weight of LiCl inN-methyl-2-pyrrolidinone (NMP).

Approximately 3 grams of about 13% (w/v) oxidized solution in NMP wasadded into a glass scintillation vial into which about 1 gram of iohexol(including about 300 mg of iodine) contrast solution was also added. Thevial was capped and vortexed for about 30 seconds.

The resulting solution was added drop-wise to a 2 liter glass beakercontaining about 400 mL of heavy mineral oil and about 800 mL cottonseedoil and mixed. Subsequently, about 15 mL of isopropyl myristate wasadded to the beaker along with an additional 200 mL of cottonseed oil tofurther extract the NMP solvent from the oxidized cellulosemicrospheres.

About 100 mL of n-heptane was then added after about 2.5 hours, followedby sieving for size fractionation at about 300 μm, 200 μm, 105 μm, and25 μm and the microspheres were harvested in each size range, thenwashed with n-heptane to remove any residual oil.

The microspheres were then transferred to a clean glass vesselcontaining about 25 mL of dichloromethane and swirled gently to furtherextract NMP and then were allowed to settle, at which time thedichloromethane was decanted and the microspheres were dried under astream of nitrogen.

The microspheres were collected on Whatman No. 4 filter paper undervacuum and air dried overnight before being bottled under an argonoverlay.

For purposes of stability, the carboxylic acid groups on themicrospheres were cross-linked with aziridine and an overcoat oftriglyceride was added. Subsequently, the microspheres were bottled in10 mL Wheaton vials under an argon overlay.

Example 17

This Example describes embolization of a blood vessel using the oxidizedcellulose including iodine contrast agent.

Oxidized cellulose microspheres of Example 16 were implanted into ablood vessel as shown in the angiograms of FIGS. 31 and 32. FIG. 31shows the blood vessel prior to implantation of the microspheresthereinto and FIG. 32 shows occlusion of the blood vessel followingimplantation.

Example 18

This Example describes formation of an oxidized cellulose slurry from a15% by weight/volume oxidized cellulose solution including 1% by weightof LiCl in N-methyl-2-pyrrolidinone (NMP).

Approximately 2 grams of about 15% (w/v) oxidized solution in NMP wasadded into a 2 liter glass beaker containing about 200 mL of heavymineral oil and about 400 mL cottonseed oil and mixed. Subsequently,about 5 mL of isopropyl myristate was added to the beaker along with anadditional 150 mL of cottonseed oil to further extract the NMP solventfrom the oxidized cellulose microspheres.

About 50 mL of n-heptane was then added after about 2.5 hours, followedby sieving for size fractionation at about 300 μm, 200 μm, 105 μm, and25 μm, and the microspheres were harvested in each size range, thenwashed with n-heptane to remove any residual oil.

The microspheres were then transferred to a clean glass vesselcontaining about 25 mL of dichloromethane and swirled gently to furtherextract NMP and then were allowed to settle, at which time thedichloromethane was decanted and the microspheres were dried under astream of nitrogen.

The microspheres were collected on Whatman No. 4 filter paper undervacuum, and air dried overnight before being bottled under an argonoverlay.

For purposes of stability, the carboxylic acid groups on themicrospheres were cross-linked with aziridine and an overcoat oftriglyceride was added. Subsequently, the microspheres were bottled in10 mL Wheaton vials under an argon overlay.

About 0.4 grams of oxidized cellulose microspheres and about 1.0 mL ofan iodixanol solution having a concentration of iodine of about 270mg/mL (available as VISIPAQUE® from GE Healthcare of Little Chalfont,United Kingdom) were then added to about 1.0 mL of a saline solution,which after about 10 minutes resulted in a polymer slurry.

Example 19

This Example describes embolization of a blood vessel in a porcineanimal model using the oxidized cellulose slurry of Example 18.

The oxidized cellulose slurry of Example 18 was implanted into a bloodvessel as shown in the angiograms of FIGS. 33 and 34. FIG. 33 shows theblood vessel prior to implantation of the microspheres therein and FIG.34 shows occlusion of the blood vessel following implantation.

Example 20

This Example describes analysis of degree of oxidation of the oxidizedcellulose of Example 1.

Degree of oxidation of dissolved oxidized cellulose was analyzed usingconductimetric and pH metric titration and compared with the degree ofoxidation of undissolved oxidized cellulose.

Multiple samples from about 90 mg to about 700 mg of undissolvedoxidized cellulose and from about 560 mg to about 4.4 grams of about 16%by weight/volume of the oxidized cellulose solution of Example 1 wereprepared. Each of the samples was dissolved in about 15 mL of a sodiumhydroxide (NaOH) solution having a molarity (M) from about 0.05 M toabout 0.5 M. The resulting solutions were titrated with a hydrogenchloride (HCl) solution from about 0.05 M to about 0.5 M on a TIM 845titration apparatus (from Radiometer Analytical SAS, Villeurganne Cedex,France) and conductimetric and pH-metric curves were obtained. A blanktitration was done in the same conditions to determine the NaOHconcentration.

The conductometric titration curves showed the presence of strongalkali, corresponding to the excess of NaOH and a weak alkalicorresponding to the carboxyl content, as shown in the illustrativeconductometric curve of FIG. 35. The characteristic pH-metric curve isshown in the FIG. 36, in which the equivalence point corresponds to theresidual NaOH in the samples.

The degree of oxidation for each sample was calculated using thefollowing formulas (I) and (II):

$\begin{matrix}{{DO} = \frac{162 \times {n\left( {C\; O\; O\; H} \right)}}{w - \left( {14 \times {n\left( {C\; O\; O\; H} \right)}} \right.}} & (I) \\{{n\left( {C\; O\; O\; H} \right)} = {\left( {{V\; 2} - {V\; 1}} \right) \times {C\left( {H\;{Cl}} \right)}}} & ({II})\end{matrix}$in which V2 is the volume of HCl in liters obtained by the blanktitration or from the conductometric curve as indicated in FIG. 35; V1is the amount HCl in liters as shown in FIG. 35, or the equivalencepoint from the pH-metric titration of FIG. 36; C is HCl concentration inmoles per liter (Mol/L) and w is the weight of the oven-dried sample ofundissolved oxidized cellulose in grams.

The degree of oxidation of non-dissolved oxidized cellulose and fordissolved oxidized cellulose of Example 1 samples are summarized inTable 3 below:

TABLE 3 Undissolved Dissolved Oxidized Oxidized Cellulose Cellulose 0.60.53 0.56 0.52 0.57 0.52 0.6 0.56 0.59 0.6 0.6 0.62 0.59 0.61 0.57 mean0.59 0.52 std dev 0.020 0.006

Example 21

This Example describes embolization of a blood vessel in a porcineanimal model using a liquid oxidized cellulose embolization solution.

About 2 mL of about 20% by weight/volume of the oxidized cellulosesolution in NMP was prepared according to process described in Example 1and was implanted into a blood vessel of a porcine kidney as shown inthe angiograms of FIGS. 37 and 38. FIG. 37 shows the blood vessel priorto implantation of the microspheres using a microcatheter, a tip ofwhich is clearly shown as a dot within the blood vessel. FIG. 38 showsocclusion of the blood vessel following implantation, which illustratesthat the embolization achieved was downstream to the microcatheter tip.The resulting embolization had a score of 0 based on the thrombolysis incerebral infarction (“TICI”) scale used to evaluate angiographicintracranial flow, as proposed by Higashida et al., “Trial design andreporting standards for intra-arterial cerebral thrombolysis for acuteischemic stroke,” Stroke 2003; 34:e109-137. A score of 0 denotes absenceof antegrade flow of blood through the vessel.

It will be appreciated that of the above-disclosed and other featuresand functions, or alternatives thereof, may be desirably combined intomany other different systems or applications. Also that variouspresently unforeseen or unanticipated alternatives, modifications,variations or improvements therein may be subsequently made by thoseskilled in the art which are also intended to be encompassed by thefollowing claims. Unless specifically recited in a claim, steps orcomponents of claims should not be implied or imported from thespecification or any other claims as to any particular order, number,position, size, shape, angle, or material.

What is claimed is:
 1. A method for forming an embolism within a bloodvessel comprising: introducing an oxidized cellulose embolizationsolution including an oxidized cellulose into a lumen of a blood vesselto form an embolism within the lumen, wherein the oxidized cellulose ispresent in an amount from about 1% by weight to 20% by weight of theoxidized cellulose embolization solution.
 2. The method according toclaim 1, further comprising guiding an implantation device comprisingthe oxidized cellulose embolization solution through the lumen.
 3. Themethod according to claim 2, wherein guiding the implantation devicecomprises imaging the blood vessel.
 4. The method according to claim 1,wherein the oxidized cellulose embolization solution includes a solventselected from the group consisting of N-methyl-2-pyrrolidinone, dimethylsulfoxide, and combinations thereof.
 5. The method according to claim 1,wherein the oxidized cellulose embolization solution includes at leastone of a bioactive agent, a visualization agent, a radioactive material,a hemostatic agent, or a radio-protective agent.
 6. The method accordingto claim 1, further comprising: adjusting recanalization time of theembolism.
 7. The method according to claim 6, wherein adjustment of therecanalization time includes adjusting a degradation rate of theoxidized cellulose.
 8. The method according to claim 7, whereinadjustment of the degradation rate of the oxidized cellulose includesadjusting at least one of degree of oxidation or molecular weightdistribution of the oxidized cellulose.
 9. A method for treating a tumorcomprising: identifying at least one arterial blood vessel supplyingblood to a tumor; selecting at least one of degree of oxidation ormolecular weight distribution of an oxidized cellulose of an oxidizedcellulose embolization solution, the oxidized cellulose present in anamount from about 10% by weight to about 20% by weight of the oxidizedcellulose embolization solution; guiding an implantation deviceincluding the oxidized cellulose embolization solution through a lumenof the at least one arterial blood vessel; and introducing the oxidizedcellulose embolization solution into the lumen through the implantationdevice to form an embolism within the lumen and impede supply of bloodto the tumor, wherein recanalization time of the embolism is based onthe selection of at least one of the degree of oxidation or themolecular weight distribution of the oxidized cellulose.
 10. The methodaccording to claim 9, wherein guiding the implantation device comprisesimaging the at least one arterial blood vessel.
 11. The method accordingto claim 9, wherein the oxidized cellulose embolization solutionincludes a solvent selected from the group consisting ofN-methyl-2-pyrrolidinone, dimethyl sulfoxide, and combinations thereof.12. The method according to claim 9, wherein the oxidized celluloseembolization solution includes at least one of a bioactive agent, avisualization agent, a radioactive material, a hemostatic agent, or aradio-protective agent.
 13. The method according to claim 9, furthercomprising adjusting a degradation rate of the oxidized cellulose toadjust the recanalization time of the embolism.
 14. A method for formingan embolism within a blood vessel comprising: selecting at least one ofdegree of oxidation or molecular weight distribution of oxidizedcellulose of an oxidized cellulose embolization solution, the oxidizedcellulose present in an amount from about 10% by weight to about 20% byweight of the oxidized cellulose embolization solution; and introducingthe oxidized cellulose embolization solution into a lumen of a bloodvessel to form an embolism within the lumen, wherein recanalization timeof the embolism is adjusted by the adjustment of at least one of thedegree of oxidation or the molecular weight distribution of the oxidizedcellulose.
 15. The method according to claim 14, further comprisingguiding an implantation device comprising the oxidized celluloseembolization solution through the lumen.
 16. The method according toclaim 15, wherein guiding the implantation device comprises imaging theblood vessel.
 17. The method according to claim 14, wherein the oxidizedcellulose embolization solution includes a solvent selected from thegroup consisting of N-methyl-2-pyrrolidinone, dimethyl sulfoxide, andcombinations thereof.
 18. The method according to claim 14, wherein theoxidized cellulose embolization solution includes at least one of abioactive agent, a visualization agent, a radioactive material, ahemostatic agent, or a radio-protective agent.
 19. The method accordingto claim 14, further comprising adjusting a degradation rate of theoxidized cellulose to adjust the recanalization time of the embolism.